CT Protocols: (Brain, ENT, Spine, Vascular) - Department of Radiology

Name / MRN: ___________________ / ________________ 

DOB: _______________ / Date of Scan: ______________ _____ Pediatric Brain 

1 Revised 7/22/09 (Gentry/Ranallo) 

CT Protocols: (Brain, ENT, Spine, Vascular) 

Brain: 

Protocoled By: Dr. _________________________ _____ Pediatric Trauma (< 6 y/o) _____ add 3D CT 

Monitored By: Dr. _________________________ 

_____ Adult Brain 

CT Tech Name & #: ________________ / ____________ _____ Pituitary & Cavernous Sinus 

CT Scanner: ______________________________ _____ Stealth (Whole Brain Treatment Planning) 

Contrast: 

Facial Trauma: 

_____ Without _____ Without and Check _____ Face and Mandible (No 3D) 

_____ With _____ With and Without _____ Face and Mandible (With 3D) 

_____ Orbit Only (use only for blowout Fxs) 

Spine: 

_____ Adult _____ (craniosynostosis, congenital facial anomaly) 

_____ Pediatric (< 6 Y/O) 

_____ Post-Myelogram 

_____ Haughton Rotational 

3D CT 

Sinuses: 

_____ Pediatric Diagnostic ( < 6 y/o) 

_____ Stealth: Stealth Levels ____________ _____ Adult Diagnostic 

Spine Levels - Coverage 

_____ Follow-up Adult ENT Sinus 

___ Cervical ___ Thoracic ___ Lumbar ___ Sacral Stealth (Landmarks) Only (No Longer Done per Dr Gentry) 

Vascular Imaging: (CT/CTA/Perfusion) 

Orbit: (non-traumatic) 

_____ Stroke Deluxe: (Acute Stroke Workup) _____ Routine 

Includes: CTA head/neck/arch, CT perfusion, CT head w/o & w/ 

_____ Vascular Mass or CC-Fistula 

_____ Total Cerebrovascular: (Stenosis, Trauma, Unknown Bleed) _____ With Valsalva 

Includes: CTA head/neck/arch, CT perfusion, CT head w/o & w/ 

_____ Dynamic Multipositional 

_____ 

_____ 

CTA Head Only: (Cerebrovascular Disease, Unknown Bleed) 

___ With Perfusion ___ Without Perfusion Temporal Bone: (adult or peds) 

Includes: CTA head, CT head w/o & w/, +/- perfusion ____ W/O ____ W/ ____ Both ____ Vascular Mass 

CTA Neck Only: (Cerebrovascular Disease) 

Includes: CTA neck and arch 

_____ CT Venography: _____ Head _____ Head & Neck _____ Routine 

Includes: CTV head +/- neck, CT head w/o & w/ 

_____ Salivary Gland Calculi (W/O & W/) 

_____ Aneurysm (Hi-Res COW): (Nontraumatic SAH, Known Aneurysm) _____ Vascular Mass 

Includes: CTA head, CT head w/o & w/, no perfusion 

_____ Parathyroid Adenoma 

_____ Ala Carte Studies: 

_____ Brachial Plexus 

CTA: _____ Head _____ Neck & Arch _____ Add on Neck Options 

Perfusion: _____ Yes _____ No _____ Puffed Cheek _____ Valsalva 

_____ Vocalization _____ Perfusion CT 

CT Perfusion (Levels – Coverage) 

_____ Acute Stroke: 

_____ Carotid Stenosis: 

_____ Posterior Fossa: 

(Vertebrobasilar Insufficiency) 

Neck – Nasopharynx – Larynx: 

Other Protocol:

Table of Contents: 


Page # Protocol Exam 

5 1.1 Adult Head – Routine Helical 

8 1.2 Adult Head – Helical Scan with Angled Axial Reformations 

11 1.3 Adult Head – Axial 

13 11.1 & 11.2 Pediatric Head – Routine Helical 

17 11.3 & 11.4 Pediatric Head – Helical Scan with Angled Axial Reformations 

21 11.5 & 11.6 Pediatric Head – Axial 

24 11.7 & 11.8 Pediatric Head – Trauma 

27 2.1 Orbit – Routine 

33 2.2 Orbit – With and Without Valsalva 

34 2.3 Orbit – Vascular Mass or Carotid-Cavernous Fistula 

36 2.4 Orbit – Dynamic – EOM Movements 

27 12.1 &12.2 Pediatric Orbit – Routine 

33 12.3 & 12.4 Pediatric Orbit – With and Without Valsalva 

34 12.5 & 12.6 Pediatric Orbit – Vascular Mass or Carotid-Cavernous Fistula 

36 12.7 & 12.8 Pediatric Orbit – Dynamic – EOM Movements 

37 2.5a Maxillofacial Trauma – Routine 

43 2.5b Maxillofacial Trauma – Routine plus 3D 

37 12.9 & 12.10 Pediatric Maxillofacial Trauma – Routine 

43 12.9 & 12.10 Pediatric Maxillofacial Trauma – Routine plus 3D 

44 1.5 3D CT – Craniosynostosis, Congenital Facial Anomaly 

44 11.9 & 11.10 Pediatric 3D CT – Craniosynostosis, Congenital Facial Anomaly 

48 2.6 Pituitary Gland and Cavernous Sinus 

48 12.11 & 12.12 Pediatric Pituitary Gland and Cavernous Sinus 

52 1.10 Stealth – Stereotactic Head (Whole Brain Treatment Planning) 

52 11.11 & 11.12 Pediatric Stealth – Stereotactic Head (Whole Brain Treatment Planning) 

53 2.7 Sinuses – Diagnostic 

53 12.13 & 12.14 Pediatric Sinuses – Diagnostic 

59 2.8 Sinuses – Follow-up Adult ENT Sinus 

61 2.9 Sinuses – Conbined Diagnostic and Landmark 

61 12.16 & 12.17 Pediatric Sinuses – Conbined Diagnostic and Landmark 

62 2.10 Temporal Bone and Posterior Fossa (W/O Contrast) 

62 12.18 & 12.19 Pediatric Temporal Bone and Posterior Fossa (W/O Contrast) 

66 2.11 Temporal Bone and Posterior Fossa (W/O and W Contrast) 

66 12.20 & 12.21 Pediatric Temporal Bone and Posterior Fossa (W/O and W Contrast) 

70 2.12 Temporal Bone – Vascular Mass 

70 12.22 & 12.23 Pediatric Temporal Bone – Vascular Mass 

75 3.1 Neck – Routine 

75 3.2 Neck – Feet First 

81 3.1 Neck – Salivary Gland 

82 3.3 Neck – Vascular Mass

Table of Contents (continued): 


Page # Protocol Exam 

84 3.5 Neck – Add on Options 

86 3.4 Neck – Parathyroid Adenoma 

75 13.1 Pediatric Neck – Routine 

75 13.2 Pediatric Neck – Feet First 

81 13.1 Pediatric Neck – Salivary Gland 

82 13.3 Pediatric Neck – Vascular Mass 

86 3.4 Pediatric Neck – Parathyroid Adenoma 

84 13.5 Pediatric Neck – Add on Options 

90 3.1 Brachial Plexus – Adult 

90 13.1 Brachial Plexus –Pediatric 

91 3.5 Cervical Spine – Adult 

93 7.5 Thoracic Spine – Feet First – Adult 

94 7.6 Thoracic Spine – Head First – Adult 

95 7.1 Lumbar Spine – Feet First – Adult 

97 13.5 Cervical Spine – Pediatric 

100 17.5 Thoracic Spine – Pediatric 

103 17.1 Lumbar Spine – Pediatric 

106 7.2 Stealth (Stereotactic) Spine 

107 1.6 & 3.7 Vascular Imaging: Stroke Deluxe (Acute Stroke Workup) 

111 1.6a Vascular Imaging: Total Cerebrovascular 

112 1.7 Vascular Imaging: CTA Head Only (Stenosis, Unknown Bleed) 

116 1.8 Vascular Imaging: Aneurysm (Hi-Res COW) (Non-traumatic SAH, Known Aneurysm) 

120 3.8 Vascular Imaging: CTA Neck Only (Cerebrovascular Disease) 

124 1.9 & 3.9 Vascular Imaging: CT Venography 

107 11.16 & 11.17 Pediatric Vascular Imaging: Stroke Deluxe (Acute Stroke Workup) 

111 11.16 & 11.17 Pediatric Vascular Imaging: Total Cerebrovascular 

112 11.18 & 11.19 Pediatric Vascular Imaging: CTA Head Only (Stenosis, Unknown Bleed) 

116 11.20 & 11.21 Pediatric Vascular Imaging: Aneurysm(Hi-Res COW)(Non-trauma SAH, Known Aneurysm) 

120 11.22 & 11.23 Pediatric Vascular Imaging: CTA Neck Only (Cerebrovascular Disease) 

124 11.24 & 11.25 Pediatric Vascular Imaging: CT Venography 

128 Appendix #1 CTA Head: 2D Thin and Thick Slab Reformations 

129 Appendix #2: CTA Neck: 2D-Reformations 

130 Appendix #3: CT Perfusion Protocol 

131 Appendix #4: CT Perfusion Coverage 

132 Appendix #5: CT Perfusion Analysis Instructions 

138 Appendix #6: Neck CT Contrast Timing for Routine Neck CT 

139 Appendix #7: 64 Slice Scanner Prioity 

140 Appendix #8: CT Scanner Type 

141 Appendix #9: CT Scanner Limits 

142 Appendix #10: Direction and Naming of 2D-Reformations 

143 Appendix: #11 Combined Neuro and Body Contrast Studies


Scanner Nomenclature: 

Scanner - 

Location 

# of 

Slices 

Maximum mA 

at 120 kV 

Scanner Name 

Naming Convention 

in this Protocol Book 

CTI – 1 16 800 Lightspeed Xtra 

CTI – 2 4 440 LightSpeed 16 

CTI – 3 16 800 LightSpeed 16 Pro 

CTI - 4 64 800 LightSpeed VCT 64 

ER 64 800 LightSpeed VCT 64 

CT-RP 8 440 LightSpeed 8 

East 8 440 LightSpeed 8 

LS Xtra 

LS 16 

LS 16 Pro 

LS VCT 64 

LS VCT 64 

LS 8 

LS 8


Adult Head: Routine (Helical Mode) (Protocol # 1.1) 

Billing: 1. CT Head without, or with, or without and with 

2. Contrast if used 

Setup: 1. Supine, AP and lateral scouts, no gantry angle 

2. Helical mode should be used routinely for adult head CT scans. Only use axial mode 

when you cannot move the patient’s head into proper position (trauma, cervical 

collar, rigid neck). 

3. Patient Positioning: Tilt the patients head so that a line connecting the lateral 

canthus of the eye and the EAC is perpendicular to the CT tabletop (see below). Use 

axial mode and angle the gantry if you cannot place the patient’s head within 15 

degrees of the proper setup angle. 

4. Start scans at the bottom of C1 and scan through the top of the head 

DFOV: Preferred 20 cm (Range 18-22) 

Contrast: 1. 150 ml of 240 mg/dl non-ionic contrast @ 0.6 ml/sec (4.2 minutes) 

2. Begin scanning as soon as contrast injection is finished 

Other Info:


Head: Helical 

Adult 

Non-Contrast 

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT 

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8 

Scan Type Helical Helical Helical Helical Helical 

Rotation Time (sec) 0.5 0.6 0.4 0.4 0.7 

Detector Coverage (mm) 

Beam Collimation (mm) 

10 10 10 20 10 

Detector Rows 16 16 16 16 8 

Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25 

Slice Thickness (mm) 5 5 5 5 5 

Interval (mm) 2.5 2.5 2.5 2.5 2.5 

Scan FOV Head Head Head Head Head 

kV 120 120 120 120 120 

Smart mA/ Auto mA Range 200-660 130-440 200-660 190-620 130-440 

Noise Index 2.8 2.8 2.8 2.8 2.8 

(Manual mA) 530 350 530 500 340 

Recon 1: 

DFOV 22 22 22 22 22 

Recon Type Soft Soft Soft Soft Soft 

WW/ WL 80/25 80/25 80/25 80/25 80/25 

Recon Option Full Full Full Full Full 

Recon 2: 

DFOV 22 22 22 22 22 

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus 

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5 

Interval (mm) 1.25 1.25 1.25 1.25 1.25


Head: Helical 

Adult 

Contrast 







10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 2.5 2.5 2.5 2.5 2.5 


kV 100 100 100 100 100 


Noise Index 3.3 3.3 3.3 3.3 3.3 

(Manual mA) 620 330 600 570 340 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 90/30 90/30 90/30 90/30 90/30 


Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 



Interval (mm) 1.25 1.25 1.25 1.25 1.25


Adult Head: Helical Scan with Angled Axial Reformations (Protocol # 1.2) 



Setup: 1. Use this protocol when the head cannot be properly positioned for a routine helical 

head scan. Example: when you cannot move the patient’s head into proper position 

(trauma, cervical collar, rigid neck). 

2. Supine, AP and lateral scouts, no gantry angle 

3. Start the scans at C2 and scan through the top of the head 

4. Do not send the source images to PACS (Only send the 2D-reformations) 

5. Obtain 2D-reformations parallel to a line connecting the infraorbital rim with the 

opisthion (see below). Use a sagittal view on Imageworks slightly off midline to 

choose proper angle of reconstruction. Start reformations at the bottom of C1 and 

go to the top of the head using a 20 cm DFOV. 

6. Important: Be certain that dental filling artifact does not extend across the brain on 

the helical raw data. If it does, then use the axial mode head protocol instead. 




Other Info: 1. 2D-Reformations 

a. Axial Soft Tissue: 5 mm thick with an interval of 2.5 mm 

b. Axial Bone: 2.5 mm thick with an interval of 1.25 mm


Head: Helical Scan with Angled Axial 

Reformations - Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.65 0.65 0.65 0.65 0.65 


kV 120 120 120 120 120 


Noise Index 5.6 5.6 5.6 5.6 5.6 

(Manual mA) 440 350 420 400 340 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 80/25 80/25 80/25 80/25 80/25 

Recon Option Plus Plus Plus Full Plus 

Recon Option 

Recon 2: 

IQ Enhance 

DFOV 22 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 0.75



Reformations - Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.65 0.65 0.65 0.65 0.65 


kV 100 100 100 100 100 


Noise Index 6.6 6.6 6.6 6.6 6.6 

(Manual mA) 630 330 600 570 340 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 90/30 90/30 90/30 90/30 90/30 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 22 22 22 22 22 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 0.75

Adult Head: (Axial Mode) (Protocol # 1.3) 




Setup: 1. Supine, AP and lateral scouts 

2. Helical mode should be used routinely `for adult head CT scans. Only use axial 

mode when you cannot move the patient’s head into proper position (trauma, 

cervical collar, rigid neck). This mode can also be used in unstable patients in the 

emergency department when the CT scan time must be expedited. 

3. Patient Positioning: Using the lateral scout image, angle the gantry so that it is 

parallel to a line connecting the infraorbital rim with the opisthion (see below). 





Other Info:


Head: Axial 

Adult 

Non-Contrast 



Scan Type Axial Axial Axial Axial Axial 




10 10 10 10 10 


Number of Images per 

Rotation 

2i 2i 2i 2i 2i 




kV 120 120 120 120 120 

mA 670 420 630 630 420 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 80/25 80/25 80/25 80/25 80/25 

Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Head: Axial 

Adult 

Contrast 







10 10 10 10 10 



Rotation 

2i 2i 2i 2i 2i 




kV 100 120 100 100 120 

mA 670 400 670 670 400 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 90/30 90/30 90/30 90/30 90/30 

Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5


Pediatric Head: Routine (Helical Mode) (< 6 years of age) 

(Protocol # 11.1 & 11.2) 



Setup: 1. Supine, AP and lateral scouts, no gantry angle 

2. Helical mode should be used routinely for pediatric head CT scans. Only use axial 


cervical collar, rigid neck). 


canthus of the eye and the EAC is perpendicular to the CT tabletop (see below). Use 

axial mode and angle the gantry if you cannot place the patient’s head within 15 

degrees of the proper setup angle. 


Preferred: 

Preferred 16 cm (Range 14-18 cm) 

Contrast: 1. 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec 


Patient Age: 

Choose the CT scan factors on the scanner for the proper age range of the patient 

1. Child: (3 – 6 years) 

2. Infant: (0 – 3 years) 

Other Info:


Head: Helical 

Pediatric Child (3 – 6 yr) 

Non-Contrast 







10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 2.5 2.5 2.5 2.5 2.5 

Scan FOV Head Head Head Small Head Head 

kV 100 100 100 100 100 


Noise Index 2.6 2.6 2.6 2.6 2.6 

(Manual mA) 510 340 510 480 330 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 80/25 80/25 80/25 80/25 80/25 


Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 



Interval (mm) 1.25 1.25 1.25 1.25 1.25


Head: Helical 


Contrast 







10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 2.5 2.5 2.5 2.5 2.5 


kV 80 80 80 80 80 


Noise Index 3.0 3.0 3.0 3.0 3.0 

(Manual mA) 560 340 540 510 310 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 80/25 80/25 80/25 80/25 80/25 


Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 



Interval (mm) 1.25 1.25 1.25 1.25 1.25


Head: Helical 

Pediatric Infant (0– 3 yr) 

Non-Contrast or Contrast 







10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 1.5 1.5 1.5 1.5 1.5 


kV 80 80 80 80 80 


Noise Index 3.3 3.3 3.3 3.3 3.3 

(Manual mA) 460 260 460 430 260 

Recon 1: 

DFOV 20 20 20 20 20 

Recon Type Standard Standard Standard Standard Standard 

WW/ WL 80/25 80/25 80/25 80/25 80/25 

Recon Option Plus Plus Plus Plus Plus 

Recon 2: 

DFOV 20 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 



Interval (mm) 1.25 1.25 1.25 1.25 1.25


Pediatric Head: Helical Scan with Angled Axial Reformations (< 6 years of age) 

(Protocol # 11.3 & 11.4) 



Setup: 1. Use this protocol when the head cannot be properly positioned for a routine helical 

head scan. Example: when you cannot move the patient’s head into proper position 

(trauma, cervical collar, rigid neck) 

2. Supine, AP and lateral scouts, no gantry angle 

3. Start the scans at C2 and scan through the top of the head 

4. Do not send the source data to PACS (Only send the 2D-reformations) 

5. Obtain 2D-reformations parallel to a line connecting the infraorbital rim with the 

opisthion (see below). Start reformations at the bottom of C1 and go to the top of the 

head using a 20 cm DFOV. 

6. Important: Be certain that dental filling artifact does not extend across the brain on 

the helical raw data. If it does, then use the axial mode head protocol instead. 

DFOV: 




Patient Age: 




Other Info: 1. 2D-Reformations 

a. Axial Soft Tissue: 5 mm thick with an interval of 2.5 mm 

b. Axial Bone: 2.5 mm with an interval of 1.25 mm



Reformations - Pediatric Child (3 – 6 yr) 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.375 0.375 0.375 0.312 0.75 


kV 100 100 100 100 100 


Noise Index 5.2 5.2 5.2 5.2 5.2 

(Manual mA) 420 340 400 380 330 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 80/25 80/25 80/25 80/25 80/25 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 22 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 0.75



Reformations - Pediatric Child (3 – 6 yr) 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.375 0.375 0.375 0.312 0.75 


kV 80 80 80 80 80 


Noise Index 6.0 6.0 6.0 6.0 6.0 

(Manual mA) 560 340 540 510 310 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 80/25 80/25 80/25 80/25 80/25 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 22 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 0.75



Reformations - Pediatric Infant (0– 3 yr) 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.375 0.375 0.375 0.312 0.75 


kV 80 80 80 80 80 


Noise Index 6.6 6.6 6.6 6.6 6.6 

(Manual mA) 370 260 360 340 260 

Recon 1: 

DFOV 20 20 20 20 20 


WW/ WL 80/25 80/25 80/25 80/25 80/25 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 20 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 0.75


Pediatric Head: (Axial Mode) (Less than 6 years of age) (Protocol # 11.5 & 11.6) 



Setup: 1. Supine, AP and lateral scouts 

2. Helical mode should be used routinely for pediatric head CT scans. Only use axial 


cervical collar, rigid neck). This mode can also be used in unstable patients in the 

emergency department when the CT scan time must be expedited. 

3. Patient Positioning: Using the lateral scout image, angle the gantry so that it is 

parallel to a line connecting the infraorbital rim with the opisthion (see below). 


DFOV: 




Patient Age: 

Other Info: 



2. Infant: (0 – 3 years)


Head: Axial 


Non-Contrast 







10 10 10 10 10 



Rotation 

2i 2i 2i 2i 2i 




kV 100 100 100 100 100 

mA 640 420 600 600 420 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 80/25 80/25 80/25 80/25 80/25 

Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Head: Axial 


Contrast 







10 10 10 10 10 



Rotation 

2i 2i 2i 2i 2i 




kV 80 100 80 80 100 

mA 670 420 600 600 420 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 80/25 80/25 80/25 80/25 80/25 

Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 



Head: Axial 

Pediatric Infant (0– 3 yr) 








10 10 10 10 10 



Rotation 

2i 2i 2i 2i 2i 




kV 80 80 80 80 80 

mA 660 400 640 640 400 

Recon 1: 

DFOV 20 20 20 20 20 


WW/ WL 80/25 80/25 80/25 80/25 80/25 

Recon 2: 

DFOV 20 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 



Pediatric Head: (Trauma) (< 6 y/o) (with or without 3D CT) (Protocol # 11.7 & 11.8) 

Billing: 1. CT Head without 

2. 3D CT Head if done 

Setup: 1. Patient Supine, AP and lateral scouts, no gantry angle 

3. Remove all metallic and high-density objects from the scanning area 

3. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral 

canthus of the eye and the EAC is perpendicular to the CT tabletop (see below). 

4. Start scans at the bottom of C1 and scan completely through the top of the head 

5. Must be done with helical mode. 

DFOV: 

Patient Age: 





Contrast: 1. None 

Other Info: 1. See Maxillofacial Trauma Protocol for more information on 3D reconstructions. 

2. 3D Exam: Please perform three 360 0 rotations at 10 0 intervals as follows 

a. From a right lateral view = rotate the head horizontally for 360 0 

b. From an AP view = rotate vertically for 360 0 

c. From a Water’s type view = rotate horizontally for 360 0 (note: to get a Water’s type 

projection rotate the patient’s nose upward about 20 0 ) 

3. Networking 3D images to ALI Store 

4. Place the 3D request in the 3D slot on the wall in the E3/3 control room!


Head Trauma: Helical 







10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 2.5 2.5 2.5 2.5 2.5 


kV 100 100 100 100 100 


Noise Index 2.6 2.6 2.6 2.6 2.6 

(Manual mA) 510 340 510 480 330 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 80/25 80/25 80/25 80/25 80/25 


Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Head Trauma: Helical 

Pediatric Infant (0 – 3 yr) 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 1.5 1.5 1.5 1.5 1.5 


kV 80 80 80 80 80 


Noise Index 3.3 3.3 3.3 3.3 3.3 

(Manual mA) 460 260 460 430 260 

Recon 1: 

DFOV 20 20 20 20 20 


WW/ WL 80/25 80/25 80/25 80/25 80/25 

Recon Option Plus Plus Plus Plus Plus 

Recon 2: 

DFOV 20 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Orbit: (Routine) (Protocol – Adult: # 2.1 – Pediatric: # 12.1 & 12.2) 

Billing: 

Setup: 

DFOV: 

Contrast: 

Patient Age: 

1. CT Orbit without, or with, or with and without 


1. Patient Supine, AP and lateral scouts, no gantry angle. 

2. Extend the scouts to include aortic arch for smart prep. 

3. Patient Positioning: Tilt the patients head so that a line connecting the lateral canthus 

of the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol). 

You may need to put a foam pad under the occiput to get the head in this position. 

4. Ask the patient to look straight ahead and hold their eyes in a very still position. 

5. Start the scans at the infraorbital rim and scan through the top of the orbit 


1. Adults: 75 ml of 240 mg/ml nonionic contrast media (use 150ml of 240mg/ml if a CT 

of the head will also be obtained) 

2. Pediatrics: 1 ml / pound (2 ml/kg) of 240 non-ionic contrast media 

3. Injection Rate: Adults: 3 ml/sec; Pediatric: 2 ml/sec 

4. Smart prep over the cavernous sinus (adults) or aortic arch (peds). Begin scanning 

10 seconds (adults) or 6 seconds (pediatric) after arrival of contrast. 




Recons & Reformats: 

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats. Do them in 

the coronal and bilateral oblique sagittal planes as shown in the image below. 

2. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using 

both the standard 1.25 mm images (Recon 1) AND the bone 0.625 mm images (Recon 3) 

3. If this is a “with & without” contrast study: Do not do Recons 2 and 3 on the contrast scan. 

Do 2D-reformats using the 1.25 mm standard algorithm images (Recon 1) only from the 

contrast series AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images 

from the non-contrast series (Recon 3). 

4. Do not send the 0.625 mm (Recon 3) bone images to PACS.


Orbit: Routine 

Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 120 120 120 120 120 


Noise Index 5.6 5.6 5.6 5.6 5.6 

(Manual mA) 440 350 420 400 340 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 300/0 300/0 300/0 300/0 300/0 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Recon 3: 

DFOV 18 18 18 18 

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus 

WW/ WL 3000/300 3000/300 3000/300 3000/300 

Recon Option Plus Plus Plus Full 

Recon Option 

Non-Contrast 


IQ Enhance 

Slice Thickness (mm) 0.625 0.625 0.625 0.625 

Interval (mm) 0.375 0.375 0.375 0.312


Smart Prep 

Prep Over 

mA 

Monitoring Delay 

(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Diagnostic Delay 

(sec) 

Cavernous Sinus 80 10.0 2.0 50 12.0 


Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 6.6 6.6 6.6 6.6 6.6 

(Manual mA) 620 330 600 570 340 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 350/20 350/20 350/20 350/20 350/20 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 18 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 


Recon Option 

IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Recon 3: 

DFOV 18 18 18 18 


WW/ WL 3500/350 3500/350 3500/350 3500/350 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312









10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 5.2 5.2 5.2 5.2 5.2 

(Manual mA) 420 290 400 380 290 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 300/0 300/0 300/0 300/0 300/0 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Recon 3: 

DFOV 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 2.0 50 6.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 6.0 6.0 6.0 6.0 6.0 

(Manual mA) 510 340 460 510 340 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 300/0 300/0 300/0 300/0 300/0 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Recon 3: 

DFOV 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 2.0 50 6.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 5.1 5.1 5.1 5.1 5.1 

(Manual mA) 370 260 360 340 260 

Recon 1: 

DFOV 15 15 15 15 15 


WW/ WL 300/0 300/0 300/0 300/0 300/0 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 15 15 15 15 15 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Recon 3: 

DFOV 15 15 15 15 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312


Orbit: (With and Without Valsalva) (Protocol – Adult: # 2.2 – Pediatric: # 12.3 & 12.4) 

Billing: 

Setup Info: 

1. CT Orbit with or with and without 

2. Contrast 

1. Monitored Exam: ENT attending or fellow 

2. Patient Supine, AP and lateral scouts, no gantry angle 



canthus of the eye and the EAC is perpendicular to the CT tabletop (see head 

CT protocol). You may need to put a foam pad under the occiput to get the head 

in this position. 



7. Always done following either a routine orbit CT with contrast or a vascular mass 

CT of the orbit with and without contrast 

Exam: 

Part 1: 

Routine Orbit CT with contrast or Orbit Vascular Mass CT without and with contrast 

Part 2: Valsalva Protocol (as below) 

- Use routine orbit scan factors (but only Recon 1 – No bone images) 

- To be monitored by ENT attending or ENT fellow if possible 

- If there is any indication of increased intra-orbital or intra-ocular pressure, the 

radiologist should 1st clear this procedure with the ordering ophthalmologist 

- First rehearse the maneuver with the patient 

- Ask the patient to take a deep breath and Valsalva for 15 seconds (do not do 

CT scans at this point) 

- Have the patient take another deep breath, then 

- Do Valsalva maneuver again. 

- Begin 1.25 mm helical scans through entire orbit 5 seconds after the start of 

the 2 nd Valsalva maneuver 

- Acquire 1.25 mm helical images in axial plane using just the standard 

algorithm (no bone algorithm) 

DFOV: 

Reformats: 


1. Do the routine 2D orbital reformations for Part 1. 

2. Do additional 2 x 2 mm 2D-reformations (soft tissue only) from the post Valsalva 

images in Part 2 in the coronal and bilateral oblique sagittal planes as shown below.

Orbit: (Vascular Mass or Carotid-Cavernous Fistula) 

(Protocol – Adult: # 2.3 – Pediatric: # 12.5 & 12.6) 

Billing: 

Setup: 

DFOV: 

Exam: 

Reformats: 

Part 1: 

Part 2: 

Part 3: 

1. CT Orbit (with and without) 

2. Contrast 



2. Extend the scouts to include aortic arch and superior vena cava for smart prep. 

3. Always do exam with and without contrast 







14 cm (14-16 cm) 

Routine Orbit CT without contrast 

- Standard algorithm (Recon 1) only (no bone algorithm images & no reformats) 

Dynamic CT scans through lesion (as described below and on next page) 

- Choose eight 2.5 mm slices through the mass for dynamic scans 

- Smart prep over the superior vena cava 

- To be monitored by ENT attending or ENT fellow if possible 

- Adults: Inject 100 ml of 240mg/ml at 3.5 ml per sec (Injection time = 28.5 sec) 

(note: use 150ml of 240mg/ml if a CT of the head will also be obtained) 

- Pediatrics: Inject 1 ml/lb (2 ml/kg) of 240 mg/ml contrast at 2 ml per sec 

- Begin scanning with the arrival of contrast in the superior vena cava 

- 1 image per sec X 5 (Using Cine Mode), then 1 image every 3 sec. X 3, then 1 

image every 10 seconds X 2 (5 groups using Axial Mode with a Prep Group 

Delay of 2 sec and 9 sec respectively) (scan time = 34 sec). 

- Use 100 kV; 300 mA for adults, 150 mA for peds less than 6 y/o. 

- Allow all of the contrast to be injected then do Part 3 

- no reformats or bone algorithm with Part 2, only axial standard 2.5 mm images 

Post-contrast Orbit CT 

- Scan as in routine orbit “with contrast” protocol performing all 3 Recons: 

standard, bone and, thin bone 

1. Only do 2D-Reconstructions from the Part 3 contrast-enhanced images 

2. Do 2 mm x 2 mm 2D-reformations using both the standard 1.25 mm images 

(Recon 1) AND the bone 0.625 mm images (Recon 3) in the coronal and bilateral 

oblique sagittal planes as outlined below. 

3. Do not send the 0.625 mm (Recon 3) bone images to PACS


Scan Factors for Part 2 only: (Adult and Pediatric) 

Smart Prep 

Prep Over 

Superior Vena 

Cava 

mA 

40 (Adult) 

20 (Peds) 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

10.0 2.0 50 3.0 

Orbit: (Vascular Mass / Carotid-Cavernous Fistula) 

Adult and Pediatric 

Contrast (Part 2 Only) 



Scan Type Cine then Axial Cine then Axial Cine then Axial Cine then Axial Cine then Axial 


Detector Coverage (mm) 20 20 20 20 20 



kV 100 100 100 100 100 

mA Adults 380 300 300 300 300 

mA Peds < 6 y/o 190 150 150 150 150 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 350/20 350/20 350/20 350/20 350/20


Orbit: (Dynamic (EOM Movements) (Protocol – Adult: # 2.4 – Pediatric: # 12.7 & 12.8) 

Billing: 

Setup Info: 

Part 1: 

Part 2: 

DFOV: 

Reformats: 

1. CT Orbit without 

1. Monitored Exam: (Only scheduled and done when an ENT attending is available) 

2. Always obtained following a Routine Orbit CT without contrast 

3. Do only on 64 slice scanner 






6. Use a head restraint to help the patient hold their head still. 



Routine Orbit CT without contrast 

- The routine orbit protocol is performed as usual 

- The patient must be instructed to look straight ahead prior to the scan 

Dynamic Maneuver 

- Use the routine noncontrast orbit CT scan factors 

- Helical 1.25 mm scans will be obtained using standard algorithm only 

(no bone algorithm) 

- Ask the patient to hold their head still and only move their eyes (practice this 

with the patient ahead of time) 

- Do the following scans in these directions of gaze – IN THIS ORDER: 

- Left gaze 

- Right gaze 

- Up gaze 

- Down gaze 


1. Do the standard 2 x 2 mm 2D-reformations for the routine orbit exam (Part 1) 

2. Do additional 2 x 2 mm 2D-reformations from Part 2 the as described below. 

- Neutral gaze: coronal and bilateral oblique sagittal recons (Part 1) 

- Left gaze: No 2D recons 

- Right gaze: No 2D recons 

- Up gaze: coronal and bilateral oblique sagittal recons (Part 2) 

- Down gaze: coronal and bilateral oblique sagittal recons (Part 2)


Maxillofacial Trauma: (Routine) 

(Protocol – Adult: # 2.5a – Pediatric: # 12.9 & 12.10) 

Billing: 

Setup: 

1. CT Maxi-face without, or with, or with and without 




3. Remove all metallic and high-density objects from the scanning area. 


canthus and the EAC is perpendicular to the CT tabletop (see head CT protocol). 

5. Scanning begins just below the genu of the mandible to the top of the frontal sinuses 

Contrast: 

Patient Age 

1. Routine: w/o contrast. Use the following injection parameters if done w/ contrast. 

2. Adults: 100 ml of 240 mg/ml nonionic contrast (use 150ml of 240mg/ml if a CT head 

will also be obtained); Pediatrics: 1 ml/lb (2 ml/kg) of 240 non-ionic contrast. 

3. Injection Rate: Adults: 3.5 ml/sec; Pediatric: 2 ml/sec 

4. Smart prep over the aortic arch and begin scanning 15 seconds (adults) or 8 

seconds (pediatrics) after arrival of contrast in the arch 

: Choose the CT scan factors on the scanner for the proper age range of the patient 



DFOV: 

Preferred 17.2 cm (Range 15-18 cm) 


1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats as shown in 

the image below 

Oblique Sagittal: Through each orbit parallel to the optic nerves. 

Sagittal: 

Coronal: 

Through both orbits. Be sure to include both TMJs. 

From the anterior aspect of the superior orbital rim through the 

sella. Be sure to include all of the TMJ. 


both the standard 1.25 mm images (Recon 1) AND the bone images (Recon 2) 

3. If this is a “with & without” contrast study: Do not do Recon 2 on the contrast scan. Do 

2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series 

AND also do 2mm x 2mm reformats using the bone images (Recon 2) from the noncontrast 

series.


Maxillofacial Trauma 

Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 120 120 120 120 120 


Noise Index 5.6 5.6 5.6 5.6 5.6 

(Manual mA) 440 350 420 400 340 

Recon 1: 

DFOV 17.2 17.2 17.2 17.2 17.2 


WW/ WL 400/50 400/50 400/50 400/50 400/50 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 17.2 17.2 17.2 17.2 17.2 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.625 0.625 0.625 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 80 10.0 2.5 50 15.0 

Maxillofacial Trauma 

Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 6.6 6.6 6.6 6.6 6.6 

(Manual mA) 620 330 600 570 340 

Recon 1: 

DFOV 17.2 17.2 17.2 17.2 17.2 


WW/ WL 450/70 450/70 450/70 450/70 450/70 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 17.2 17.2 17.2 17.2 17.2 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.625 0.625 0.625 0.625 0.75


Maxillofacial Trauma: 







10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 5.2 5.2 5.2 5.2 5.2 

(Manual mA) 420 290 400 380 290 

Recon 1: 

DFOV 17.2 17.2 17.2 17.2 17.2 


WW/ WL 400/50 400/50 400/50 400/50 400/50 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 17.2 17.2 17.2 17.2 17.2 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.625 0.625 0.625 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 2.5 50 8.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 6.0 6.0 6.0 6.0 6.0 

(Manual mA) 490 340 460 510 340 

Recon 1: 

DFOV 17.2 17.2 17.2 17.2 17.2 


WW/ WL 400/50 400/50 400/50 400/50 400/50 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 17.2 17.2 17.2 17.2 17.2 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.625 0.625 0.625 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 2.5 50 8.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 5.1 5.1 5.1 5.1 5.1 

(Manual mA) 370 260 360 340 260 

Recon 1: 

DFOV 17.2 17.2 17.2 17.2 17.2 


WW/ WL 400/50 400/50 400/50 400/50 400/50 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 17.2 17.2 17.2 17.2 17.2 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.625 0.625 0.625 0.625 0.75


Maxillofacial Trauma: (Routine plus 3D) 

(Protocol – Adult: # 2.5b – Pediatric: # 12.9 & 12.10) 

Billing: 

Setup: 

Exam: 

1. CT Maxi-face without 

2. 3D CT charge 




canthus and the EAC is perpendicular to the CT tabletop (see head CT protocol). 

4. Scanning begins just below the genu of the mandible to the top of the frontal sinuses 

Part 1: Routine Maxiface Trauma Protocol 

1. Do a routine maxillofacial trauma protocol 

2. Scanning begins at the bottom of the mandible to the top of the frontal sinus (get 

one air scan below chin to allow the 3D to show the entire mandible without 

artifacts) 

Part 2: 3D Exam Post-Processing: 

1. Cut away as much of the c-spine as possible 

2. Please perform three 360 degree rotations at 10 degree intervals as follows 

a. From a right lateral view = rotate horizontally for 360 degrees 

b. From an AP view = rotate vertically for 360 degrees 

c. From a Water’s type view = rotate horizontally for 360 degrees (note: to get a 

Water’s type projection rotate the patient’s nose upward about 20 degrees) 

Other Info: 

1. Do 2 mm x 2 mm 2D-Reformations as in the routine maxifacial protocol 

2. Network the 2D and 3D images to ALI Store 

3. Place the 3D request in the 3D slot on the wall in the E3/3 control room!

3D CT: (Craniosynostosis, Congenital Facial Anomaly) 



Billing: 

Setup: 

DFOV: 

Contrast: 

Patient Age: 

Other Info: 

1. CT Head without contrast 

2. 3D CT Charge 


2. Use 64 slice scanners if possible 



canthus and the EAC is perpendicular to the CT tabletop. (see head CT protocol) 

5. Scanning begins below the genu of the mandible all the way through the top of the 

head (Get 1-2 air scans above the head and below the chin to allow the 3D program to show 

the entire head and mandible without artifacts) 

Preferred 20 cm (Range 18-22 cm) Must include the entire head, face, and mandible 

1. Only done without contrast. 




1. Send the following source images to PACS: Recon 1: 5 mm slice thickness 

standard images (2.5 mm Plus recon for infants), and Recon 2: 1.25 mm slice 

thickness bone images. 

2. Do not send the 0.625 mm (Recon 3) bone images to PACS. 

3D Reconstructions: 

1. Do 3D Reconstructions only from the Recon 3 thin bone images 

2. Cut away as much of the c-spine as possible 

3. Please perform three 360 degree rotations at 10 degree intervals as follows 

a. From a right lateral view = rotate horizontally for 360 degrees 

b. From an AP view = rotate vertically for 360 degrees 

c. From a Water’s type view = rotate horizontally for 360 degrees (note: to get a 

Water’s type projection rotate the patient’s nose upward about 20 degrees) 

4. Networking all 3D images to ALI Store 

5. Make sure the 3D request is placed in the 3D slot on the wall in the E3/3 control 

room!



Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 2.5 2.5 2.5 2.5 2.5 


kV 120 120 120 120 120 


Noise Index 2.8 2.8 2.8 2.8 2.8 

(Manual mA) 440 350 420 400 340 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 80/25 80/25 80/25 80/25 80/25 


Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Recon 3: 

DFOV 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312









10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 2.5 2.5 2.5 2.5 2.5 


kV 100 100 100 100 100 


Noise Index 2.6 2.6 2.6 2.6 2.6 

(Manual mA) 420 290 400 380 290 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 80/25 80/25 80/25 80/25 80/25 


Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Recon 3: 

DFOV 22 22 22 22 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312









10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 1.5 1.5 1.5 1.5 1.5 


kV 80 80 80 80 80 


Noise Index 3.3 3.3 3.3 3.3 3.3 

(Manual mA) 370 260 360 340 260 

Recon 1: 

DFOV 20 20 20 20 20 


WW/ WL 80/25 80/25 80/25 80/25 80/25 


Recon 2: 

DFOV 20 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Recon 3: 

DFOV 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312

Pituitary Gland and Cavernous Sinus: 



Billing: 

Setup: 

Exam: 

DFOV: 

For Part 2: 

1. CT Head with and without contrast; CT Sella with contrast 

2. Contrast 



3. Use 64 slice scanners if possible 



Part 1: CT Head Without Contrast (do as in routine CT head) 

Part 2: Pituitary CT with Contrast (as outlined below) 

- Use a DFOV of approximately 14 cm (include the orbit and the sella 

- Perform helical axial scans between yellow lines as diagramed at bottom of page 

- Use a bolus contrast injection as listed below: 

1. Adults: 150 ml of 240 mg/ml nonionic contrast at 3.5 ml/sec 

2. Pediatrics: 1 ml/lb (2 ml/kg) of 240 nonionic at 2.0 to 2.5 ml/sec 

- Smart prep over the aortic arch and begin scanning 15 seconds (adults) or 8 

seconds (pediatrics) after arrival of contrast in the arch 

- Begin Part 3 when all of contrast is in. 

Part 3: CT Head With Contrast (do as in routine CT head) 

Head: 

Pituitary: 


14 cm 

1. Only send the Standard 1.25 mm (Recon 1) images to PACS. Do not send the 

Recon 2 bone images to PACS. 

2. Do 2 mm x 2 mm 2D-reformats using both the standard 1.25 mm (Recon 1) images 

AND the bone 0.625 mm (Recon 2) images as outlined below.


Scan Factors for Part 2 only: 

Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 80 10.0 2.5 50 15.0 

Pituitary Gland and Cavernous Sinus 

Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 6.6 6.6 6.6 6.6 6.6 

(Manual mA) 620 370 600 570 370 

Recon 1: 

DFOV 14 14 14 14 14 


WW/ WL 350/20 350/20 350/20 350/20 350/20 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 14 14 14 14 14 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 0.75



Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 2.5 50 8.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 6.0 6.0 6.0 6.0 6.0 

(Manual mA) 560 340 540 510 340 

Recon 1: 

DFOV 14 14 14 14 14 


WW/ WL 300/0 300/0 300/0 300/0 300/0 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 14 14 14 14 14 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 0.75



Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 2.5 50 8.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 5.1 5.1 5.1 5.1 5.1 

(Manual mA) 370 300 360 340 290 

Recon 1: 

DFOV 12 12 12 12 12 


WW/ WL 300/0 300/0 300/0 300/0 300/0 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 12 12 12 12 12 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 0.75


Stealth - Stereotactic Head: (Whole Brain Treatment Planning) 


Billing: 

Setup: 

Contrast: 

Scan Factors: 

General Notes: 

1. CT Stereotactic 


1. Patient Supine on table top 

2. AP and lateral scouts 

3. No gantry angle 

4. Using the lasers, line up patient so that the canthomeatal line is perpendicular to 

the CT table. This may require you to tilt the patients head either up on down 

slightly. 

5. Scan from the hard palate to the top of the head 

1. Adult: 150 ml of 240 mg/dl non-ionic contrast @ 0.6 ml/sec (4.2 minutes) 

2. Peds: 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec 


Mode Axial 

Time 1 sec 

Mode 1.25 @ 8i - Interval 10.0 

KVP 120 

mA 250 

Algorithm Standard 

SFOV Head 

DFOV 22 to 25 

1. If there is ANY patient motion, start the scan over. 

2. All images should be networked to ALI Store. 

3. Archive only the axial images to the MOD that goes to the surgeon. 

4. Technical support is available 24 hours and day, 7 days a week at 800-595-9709.

Sinuses (Diagnostic): (Adult and Pediatric) 

(Protocol – Adult: # 2.7 – Pediatric: # 12.13 &12.14) 

Billing: 

Setup: 

Contrast: 

Patient Age: 

DFOV: 

1. CT Sinus without, or with, or with and without 




2. Extend the scouts to include aortic arch for smart prep if the exam is to be done with 

contrast. 



The tip of the nose and the both zygomatic bones must be on the scan. 

4. Scan from the bottom of maxillary teeth to the top of the frontal sinuses (see below) 

5. Note: If the scan is protocoled as a “with contrast” scan, start the scans at the genu 

of mandible 

6. Use axial CT scan factors if a coronal plane scan is ordered. 

1. Adults: 100 ml of 240 mg/ml nonionic contrast media; Pediatrics: 1 ml/lb (2 ml/kg) of 

240 nonionic contrast media. 

2. Injection Rate: Adults: 3.5 ml/sec; Pediatric: 0.6 to 2.5 ml/sec 

3. Smart prep over the aortic arch (use cavernous sinus if arch cannot be seen) and 

begin scanning 15 seconds (adults) or 8 seconds (pediatrics) after arrival of contrast 

in the arch 






1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats (see below) 

Sagittal: Through both orbits. Be sure to include both TMJs. 

Coronal: From the anterior aspect of the superior orbital rim through the sella. Be 

sure to include all of the TMJ. 

2. If this is an exam solely with contrast or solely without contrast: Do 2D reformats using both 

standard 1.25 mm images (Recon 1) and the bone images (Recon 2) 

3. If this is a “with & without” contrast study: Do not do Recon 2 on the contrast scan. Do 2Dreformats 

using the standard 1.25 mm images (Recon 1) only from the contrast series and 

also do 2 mm x 2 mm reformats using bone images (Recon 2) from the non-contrast series.


Sinuses (Diagnostic) 

Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 120 120 120 120 120 


Noise Index 7.2 7.2 7.2 7.2 7.2 

(Manual mA) 310 250 250 240 290 

Recon 1: 

DFOV 14 14 14 14 14 


WW/ WL 400/30 400/30 400/30 400/30 400/30 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 14 14 14 14 14 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.625 0.625 0.625 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 80 10.0 2.5 50 15.0 


Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 8.5 8.5 8.5 8.5 8.5 

(Manual mA) 450 360 360 340 340 

Recon 1: 

DFOV 14 14 14 14 14 


WW/ WL 450/50 450/50 450/50 450/50 450/50 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 14 14 14 14 14 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.625 0.625 0.625 0.625 0.75









10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 6.8 6.8 6.8 6.8 6.8 

(Manual mA) 300 240 240 230 280 

Recon 1: 

DFOV 14 14 14 14 14 


WW/ WL 400/30 400/30 400/30 400/30 400/30 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 14 14 14 14 14 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.625 0.625 0.625 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 2.5 50 8.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 7.7 7.7 7.7 7.7 7.7 

(Manual mA) 410 330 330 310 310 

Recon 1: 

DFOV 14 14 14 14 14 


WW/ WL 400/30 400/30 400/30 400/30 400/30 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 14 14 14 14 14 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.625 0.625 0.625 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 2.5 50 8.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 6.6 6.6 6.6 6.6 6.6 

(Manual mA) 280 220 220 210 250 

Recon 1: 

DFOV 14 14 14 14 14 


WW/ WL 400/30 400/30 400/30 400/30 400/30 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 14 14 14 14 14 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.625 0.625 0.625 0.625 0.75


Sinuses (Follow-up Adult ENT Sinus): (Protocol: # 2.7) 

Billing: 

Setup: 

DFOV: 

Contrast: 

Reformats: 

1. CT Sinus without only (never use this protocol when giving contrast) 


2. Only use this protocol for ENT and allergy patients with multiple prior diagnostic 

sinus CT scans 



4. Scan from the bottom of maxillary teeth to the top of the frontal sinuses (see below) 


1. Never give contrast with this protocol 

1. Do 2 mm x 2 mm 2D-reformations using both the standard 1.25 mm images AND the 

bone 0.625 mm images as shown below.


Sinuses: (Follow-up ENT) 

Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 120 120 120 120 120 


Noise Index 8.8 8.8 8.8 8.8 8.8 

(Manual mA) 210 170 170 160 190 

Recon 1: 

DFOV 14 14 14 14 14 


WW/ WL 400/30 400/30 400/30 400/30 400/30 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 14 14 14 14 14 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.625 0.625 0.625 0.625 0.75


Sinuses: (Combined Diagnostic and Landmarx): (Adult and Pediatric) 


This exam is no longer done! Do a Diagnostic Sinus CT instead. If there is any 

questions by referring doctors ask them to contact either Dr. Gentry or Dr. Hartman.


Temporal Bone: (W/O Contrast) (Protocol – Adult: # 2.10 – Pediatric: # 12.18 & 12.19) 

Billing: 

Setup: 

1. Temporal Bone without 


2. Only use 16 and 64 slice scanners 

3. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of the 

eye and the EAC is perpendicular to the CT tabletop (see below). 

4. Start scans at the mastoid tip and finish at the top of the petrous bone (see below) 

DFOV: 

Patient Age: 

1. Recon 1 and Retro Recons: Preferred 20 cm (Range 18-22 cm) 

2. Recon 2 and 3 of TB: 9.6 cm 





1. Recon 1: 2.5 mm axial images using a bone algorithm. 

2. Recon 2 & 3: Obtain left and right 0.625 mm temporal bone axial images with a DFOV of 9.6 cm. 

3. Perform 1 additional Retro Recons to get the following axial images of the entire scan range: 

At 20 cm DFOV, standard algorithm, 2.5 mm slice thickness, 1.25 mm increment, (WW/WL: 

400/30) 

4. Do 1 mm by 1 mm 2D-reformats in the coronal, Stenver’s, and Pöschl planes of each temporal 

bone using Recon 2 & 3 as source images (below)


Temporal Bone 

Adult 



Rotation Time (sec) 0.6 0.7 0.5 0.5 



10 10 10 20 

Detector Rows 16 16 16 16 

Pitch 0.562 0.562 0.562 0.531 

Speed (mm/rot) 5.625 5.625 5.625 10.62 

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 


Interval (mm) 1.25 1.25 1.25 1.25 

Scan FOV Head Head Head Head 

kV 120 120 120 120 

Smart mA/ Auto mA Range 190-610 130-420 180-590 170-560 

Noise Index 3.7 3.7 3.7 3.7 

(Manual mA) 490 340 470 450 

Recon 1: 

DFOV 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 

Recon Option Full Full Full Full 

Recon 2: 

DFOV 9.6 9.6 9.6 9.6 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 9.6 9.6 9.6 9.6 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312


Temporal Bone 







10 10 10 20 


Pitch 0.562 0.562 0.562 0.531 

Speed (mm/rot) 5.625 5.625 5.625 10.62 



Interval (mm) 1.25 1.25 1.25 1.25 

Scan FOV Head Head Head Small Head 

kV 100 100 100 100 


Noise Index 3.5 3.5 3.5 3.5 

(Manual mA) 480 330 460 430 

Recon 1: 

DFOV 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 

Recon Option Full Full Full Full 

Recon Option 

Recon 2: 9.6 9.6 9.6 9.6 

DFOV Bone Plus Bone Plus Bone Plus Bone Plus 

Recon Type 3000/300 3000/300 3000/300 3000/300 

WW/ WL Plus Plus Plus Full 

Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 9.6 9.6 9.6 9.6 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312


Temporal Bone 







10 10 10 20 


Pitch 0.562 0.562 0.562 0.531 

Speed (mm/rot) 5.625 5.625 5.625 10.62 



Interval (mm) 1.25 1.25 1.25 1.25 


kV 80 80 80 80 


Noise Index 3.4 3.4 3.4 3.4 

(Manual mA) 430 290 410 380 

Recon 1: 

DFOV 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Recon 2: 9.6 9.6 9.6 9.6 

DFOV Bone Plus Bone Plus Bone Plus Bone Plus 

Recon Type 3000/300 3000/300 3000/300 3000/300 

WW/ WL Full Full Full Full 

Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 9.6 9.6 9.6 9.6 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Non-Contrast 


IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312

Temporal Bone: (W/O & W/ Contrast) or (W/ Contrast Only): 



Billing: 

Setup: 

DFOV: 

Exam: 

1. CT Temporal Bone (without and with) 

2. Contrast 

1. Patient Supine, AP and lateral scouts, no gantry angle: 



4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of 

the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol). 

1. Posterior Fossa: Preferred 20 cm (Range 18-22 cm) 

2. TB: 9.6 cm 

Part 1: Temporal Bone CT Without Contrast 

1. Use the same protocol as described in the Temporal Bone W/O Contrast protocol 

2. This includes axial Recon 1, 2 and 3; the additional Retro recons of soft tissue and of 

bone; and all the reformatted 1 x 1 cm images of the temporal bones. 

Part 2: Temporal Bone Examination With Contrast 

1. Inject contrast and then obtain standard algorithm 1.25 mm scans with a 0.75 mm 

interval from the bottom of C1 to 1 cm above the top of temporal bone. 

2. Contrast Usage: Adults: 150 ml of 240 mg/ml nonionic contrast media; Pediatrics: 1 ml/lb 

(2 ml/kg) of 240 nonionic contrast media. 

3. Injection Rate: Adults: 3.5 ml/sec; Pediatric: 2.0 to 2.5 ml/sec 

4. Smart prep over the aortic arch and begin scanning 30 seconds (adults) or 15 seconds 

(pediatrics) after arrival of contrast in the arch. 

5. Reconstruct the 1.25 mm axial slices into 2 mm x 2 mm images of the posterior fossa 

(axial, coronal, and sagittal) using an 18-22 cm DFOV with standard algorithm only. 

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient 



Reformats: 

1. Part 1: Do 1 mm by 1 mm 2D-reformats in the coronal, Stenver’s, and Pöschl planes 

2. Part 2: Do 2 mm by 2 mm 2D-reformats in the axial, coronal, and sagittal planes 

Exam: 

Temporal Bone CT With Contrast Only 

1. Use the same technique as above except do Part 2 first then do Part 1 following the 

contrast study.


Scan Factors: (For Part 2 Only - With Contrast) 

Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 80 10.0 3 50 30.0 

Temporal Bone: (W/O & W/ Contrast) 

Adult 






10 10 10 20 


Pitch 0.562 0.562 0.562 0.531 

Speed (mm/rot) 5.625 5.625 5.625 10.62 



Interval (mm) 0.75 0.75 0.75 0.625 


kV 100 100 100 100 


Noise Index 8.8 8.8 8.8 8.8 

(Manual mA) 600 370 560 530 

Recon 1: 

DFOV 20 20 20 20 

Recon Type Standard Standard Standard Standard 

WW/ WL 400/40 400/40 400/40 400/40 


Recon Option 



IQ Enhance



Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 2.0 50 15.0 








10 10 10 20 


Pitch 0.562 0.562 0.562 0.531 

Speed (mm/rot) 5.625 5.625 5.625 10.62 



Interval (mm) 0.75 0.75 0.75 0.625 


kV 80 80 80 80 


Noise Index 7.9 7.9 7.9 7.9 

(Manual mA) 550 340 510 480 

Recon 1: 

DFOV 20 20 20 20 


WW/ WL 400/40 400/40 400/40 400/40 


Recon Option 



IQ Enhance



Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 2.5 50 15.0 








10 10 10 20 


Pitch 0.562 0.562 0.562 0.531 

Speed (mm/rot) 5.625 5.625 5.625 10.62 



Interval (mm) 0.75 0.75 0.75 0.625 


kV 80 80 80 80 


Noise Index 6.8 6.8 6.8 6.8 

(Manual mA) 430 290 410 380 

Recon 1: 

DFOV 20 20 20 20 


WW/ WL 400/40 400/40 400/40 400/40 


Recon Option 



IQ Enhance


Temporal Bone: (Vascular Mass): (Protocol – Adult: # 2.11 – Pediatric: #12.20 & 12.21) 

Billing: 

Setup: 

DFOV: 

1. CT Temporal Bone (without and with) 

2. Contrast 






5. The dynamic portion is a monitored exam by an ENT radiologist or ENT Fellow. 

1. Posterior Fossa: Preferred 20 cm (Range 18-22 cm) 

2 TB: 9.6 cm 

Exam: Part 1: Temporal Bone CT Without Contrast 

1. Use the same protocol as described in the Temporal Bone W/O Contrast protocol 

2. This includes axial Recon 1, 2 and 3; the additional Retro recons of soft tissue and of 

bone; and all the reformatted 1 x 1 cm images of the temporal bones. 

Part 2: Dynamic Contrast Enhanced Exam Through the Vascular Mass (as described below) 

1. Select eight 2.5 mm scans through the vascular mass of posterior fossa (per radiologist) 

2. 1 image per sec X 5 (Using Cine Mode), then 1 image every 3 sec. X 3, then 1 image 

every 10 seconds X 2 (5 groups using Axial Mode with a Prep Group Delay of 2 sec and 

9 sec respectively) (scan time = 34 sec). 

3. Use 100 kV; 300 mA for adults, 150 mA for peds less than 6 y/o. 

4. Standard algorithm only 

5. Inject Contrast: Adults: Inject 150 ml of 240mg/ml at 4.0 ml per sec (Injection time = 37.5 

sec). Pediatrics: Inject 1 ml/lb (2 ml/kg) of 240 mg/ml contrast at 2 ml per sec 

6. Smart prep over superior vena cava; begin scanning with arrival of contrast in the 

superior vena cava 

7. As soon as all contrast has been injected immediately start Part 3 

Part 3: Temporal Bone Examination With Contrast 

1. Inject contrast and then obtain standard algorithm 1.25 mm scans with a 0.75 mm 

interval from the bottom of C1 to 1 cm above the top of temporal bone. 

2. Reconstruct the 1.25 mm axial slices into 2 mm x 2 mm images of the posterior fossa 

(axial, coronal, and sagittal) using an 18-22 cm DFOV with standard algorithm only. 


2D Reformats: 



1. Part 1: Do 1 mm by 1 mm 2D-reformations in the coronal, Stenver’s, and Pöschl planes 

2. Part 3: Do 2 mm by 2 mm 2D-reformations in the axial, coronal, and sagittal planes


Scan Factors for Part 2 only: (Dynamic Contrast Enhanced Exam) 

Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Superior Vena Cava 40 10.0 2.0 50 3.0 

Temporal Bone: (Vascular Mass) 

Adult & Pediatric 






Detector Coverage (mm) 20 20 20 20 



kV 100 100 100 100 

mA Adults 380 300 300 300 

mA Peds < 6 y/o 190 150 150 150 

Recon 1: 

DFOV 20 20 20 20 


WW/ WL 350/20 350/20 350/20 350/20




Adult 






10 10 10 20 


Pitch 0.562 0.562 0.562 0.531 

Speed (mm/rot) 5.625 5.625 5.625 10.62 



Interval (mm) 0.75 0.75 0.75 0.625 


kV 100 100 100 100 


Noise Index 8.8 8.8 8.8 8.8 

(Manual mA) 600 370 560 530 

Recon 1: 

DFOV 20 20 20 20 


WW/ WL 400/40 400/40 400/40 400/40 


Recon Option 



IQ Enhance












10 10 10 20 


Pitch 0.562 0.562 0.562 0.531 

Speed (mm/rot) 5.625 5.625 5.625 10.62 



Interval (mm) 0.75 0.75 0.75 0.625 


kV 80 80 80 80 


Noise Index 7.9 7.9 7.9 7.9 

(Manual mA) 550 340 510 480 

Recon 1: 

DFOV 20 20 20 20 


WW/ WL 400/40 400/40 400/40 400/40 


Recon Option 

IQ Enhance




Pediatric Child (0 – 3yr) 






10 10 10 20 


Pitch 0.562 0.562 0.562 0.531 

Speed (mm/rot) 5.625 5.625 5.625 10.62 



Interval (mm) 0.75 0.75 0.75 0.625 


kV 80 80 80 80 


Noise Index 6.8 6.8 6.8 6.8 

(Manual mA) 430 290 410 380 

Recon 1: 

DFOV 20 20 20 20 


WW/ WL 400/40 400/40 400/40 400/40 


Recon Option 



IQ Enhance


Neck: (Routine) (Protocol – Adult: # 3.1 – Pediatric: # 13.1) 

Billing: 

Setup: 

DFOV: 

Contrast: 

(Feet First) (Protocol – Adult: # 3.2 – Pediatric: # 13.2) 

1. CT Neck without, or with, or without and with 


1. Patient supine, AP and lateral scouts from sella to mid chest, no gantry angle 


3. Have the patient remove any dentures or removable teeth, please place the 

shoulders as low possible 

4. Start the scan at the carina and scan to the top of the orbit 


canthus of the eye and the EAC is perpendicular to the CT tabletop (see head CT 

protocol). 

6. Do angled views at 2.5 mm 4i for 8 slices at 2 different angles if there is lots of 

artifact from dental fillings or metal hardware (see below) 

7. Note: see page 138 for protocol modifications if done as combined study with 

body/chest/abdomen/pelvis CT) 


1. Adults: 100 ml of 300 mg/ml nonionic contrast media, Pediatrics: 1 ml/lb (2 ml/kg) of 

300 non-ionic contrast media. 

2. Use a 50 ml saline chaser in adults and a 10-25 ml saline chaser in pediatrics. 

3. Injection Rate: Adults: 3.0 ml/sec; Pediatric: 2.0-2.5 ml/sec 

4. Smart prep over the aortic arch. 

5. CT scan delay after arrival of contrast in aortic arch: 

Adult: 10 sec (4-8 slice scanner), 15 sec (16 slice scanner), 20 sec (64 slice scanner) 

Peds: 5 sec (4-8 slice scanner), 8 sec (16 slice scanner), and 10 sec (64 slice scanner) 

Reformats and Recons: 

1. For Adult scans: There is a soft tissue 2.5 mm slice thickness for Recon 1, a bone plus 1.25 mm 

slice thickness for Recon 2, and a soft tissue 1.25 mm slice thickness for Recon 3. Only send 

Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 3 

for the soft tissue reformats. Use the 1.25 mm slices in Recon 2 for the bone reformats. 

2. For Pediatric scans: There is a soft tissue 1.25 mm slice thickness for Recon 1, a bone plus 

1.25 mm slice thickness for Recon 2, and a bone plus 0.625 mm slice thickness for Recon 3. 

Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in 

Recon 1 for the soft tissue reformats. Use the 0.625 mm slices in Recon 3 for the bone 

reformats. 

3. Do 2 mm by 2 mm 2D-Reformations in the coronal and sagittal planes


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 80 10.0 3.0 50 

Diagnostic Delay (sec) 

LS VCT64: 10.0 

LS 16 & 16 Pro: 15.0 

LS 4 & LS 8: 20.0 

Neck: Routine 

Adult 






20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 1.25 1.25 1.25 1.25 1.25 

Scan FOV Large Large Large Large Body Large 

kV 140 140 140 140 140 


Noise Index 11.4 11.4 11.4 11.4 11.4 

(Manual mA) 450 290 480 450 330 

Recon 1: 

DFOV 30 30 30 30 30 


WW/ WL 300/35 300/35 300/35 300/35 300/35 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 30 30 30 30 30 


WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250 


Recon Option 

IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Recon 3: 

DFOV 30 30 30 30 30 


WW/ WL 300/35 300/35 300/35 300/35 300/35 


Recon Option 



IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 80 10.0 3.0 50 



LS 16 & 16 Pro: 8.0 

LS 4 & LS 8: 10.0 

Neck: Routine 







20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 1.25 1.25 1.25 1.25 1.25 


kV 120 120 120 120 120 


Noise Index 14.9 14.9 14.9 14.9 14.9 

(Manual mA) 430 240 400 380 270 

Recon 1: 

DFOV 26 26 26 26 26 


WW/ WL 300/35 300/35 300/35 300/35 300/35 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 26 26 26 26 26 


WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250 


Recon Option 

IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Recon 3: 

DFOV 26 26 26 26 26 


WW/ WL 300/35 300/35 300/35 300/35 300/35 


Recon Option 



IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 80 10.0 3.0 50 



LS 16 & 16 Pro: 8.0 

LS 4 & LS 8: 10.0 

Neck: Routine 







20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 14.5 14.5 14.5 14.5 14.5 

(Manual mA) 360 220 350 330 220 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 300/35 300/35 300/35 300/35 300/35 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 22 22 22 22 22 


WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250 


Recon Option 

IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Recon 3: 

DFOV 22 22 22 22 


WW/ WL 300/35 300/35 300/35 300/35 


Recon Option 



IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312


Neck: Routine 

Adult – Angled Axials 








10 10 10 10 10 



Rotation 

4i 4i 4i 4i 4i 




kV 120 120 120 120 120 

mA 640 440 720 720 440 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 300/35 300/35 300/35 300/35 300/35 

Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250 


Neck: Routine 

Pediatric Child (3 – 6 yr) – Angled Axials 








10 10 10 10 10 



Rotation 

4i 4i 4i 4i 4i 




kV 100 100 100 100 100 

mA 630 420 700 700 420 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 300/35 300/35 300/35 300/35 300/35 

Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250 



Neck: Routine 

Pediatric Infant (0 – 3 yr) – Angled Axials 








10 10 10 10 10 



Rotation 

4i 4i 4i 4i 4i 




kV 80 80 80 80 80 

mA 640 400 620 620 400 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 300/35 300/35 300/35 300/35 300/35 

Recon 2: 

DFOV 22 22 22 22 22 


WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250 



Neck: (Salivary Gland) (Protocol – Adult: # 3.3 – Pediatric: # 13.3) 

Billing: 1. CT Neck (without and with) 

2. Contrast 

Setup: 1. Patient Supine (AP and lateral scouts from sella to mid chest) 

2. Make sure the patient removes any dentures or removable teeth 


Examination: 

Part 1: Limited Non-contrast CT of Neck 

- Scan from hyoid bone to EAC 

- Add angled views if there are lots of dental fillings 

- No 2D Reconstructions 

- Use same scan factors as in routine neck CT 

Part 2: Do a routine Neck CT With Contrast Protocol 

- Be sure to do angled views if there are lots of dental fillings


Neck: (Vascular Mass) (Protocol – Adult: # 3.3 – Pediatric: # 13.3) 

Billing: 

Setup: 

DFOV: 

1. CT Neck with and without 

2. Contrast 

1. Monitored exam (ENT Attending or ENT Fellow) 

2. Extend the scouts to include the superior vena cava for smart prep. 

3. Patient supine, AP and lateral scouts from sella to mid chest, no gantry angle 

4. Have the patient remove any dentures or removable teeth, please place the shoulders 

as low possible 

5. Start the scan at the carina and scan to the top of the orbit 



7. Do angled views if lots of artifact from dental fillings or metal hardware 


Exam: Part 1: Limited Non-contrast CT of Neck (scan area per radiologist) 


Part 2: Dynamic Contrast Enhanced Exam -Through the Vascular Mass (as described below) 

1. Select eight 2.5 mm scans through the vascular mass (ROI per radiologist) 

2. Use 100 kV; 300 mA for adults, 150 mA for peds less than 6 y/o. 

3. 1 image per sec X 5 (Using Cine Mode), then 1 image every 3 sec. X 3, then 1 image 

every 10 seconds X 2 (5 groups using Axial Mode with a Prep Group Delay of 2 sec 

and 9 sec respectively) (scan time = 34 sec). 


5. Smart prep over the superior vena cava. Start scanning with the arrival of contrast 

6. Adults: Inject 50 ml of 300 mg/ml at 4.0 ml per sec (Injection time = 18.7 sec) 

7. Pediatrics: Inject 0.5 ml/lb (1 ml/kg) of 300 mg/ml contrast at 2 ml per sec 

8. As soon as all contrast has been injected immediately start Part 3 

Part 3: Routine Neck CT with Contrast (with the following modifications) 

1. Perform a Routine Neck CT Protocol (Use the same scan factors as in that protocol) 

2. Adults: Begin an additional injection of 50 ml of 300 mg/ml at 3.0 ml per sec and 

immediately start scanning (no smart prep) from the carina to the top of the orbit. 

3. Pediatrics: Begin an additional injection of 0.5 ml/lb (1 ml/kg) of 300 mg/ml contrast 

at 2 ml per sec and immediately start scanning (no smart prep) from the carina to 

the top of the orbit. 

4. Use a 50 ml saline chaser in adults and a 10-25 ml saline chaser in pediatrics. 

5. Do angled views if necessary 


Part 1: No 2D recons or bone algorithm, only axial standard algorithm images 

Part 2: No 2D recons or bone algorithm, only axial standard algorithm images 

Part 3: A. Adult scans: There is a soft tissue 2.5 mm slice thickness for Recon 1, a bone plus 1.25 

mm slice thickness for Recon 2, and a soft tissue 1.25 mm slice thickness for Recon 3. 

Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm 

slices in Recon 3 for the soft tissue reformats. Use the 1.25 mm slices in Recon 2 for the 

bone reformats. 

B. Pediatric scans: There is a soft tissue 1.25 mm slice thickness for Recon 1, a bone plus 

1.25 mm slice thickness for Recon 2, and a bone plus 0.625 mm slice thickness for Recon 

3. Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm 

slices in Recon 1 for the soft tissue reformats. Use the 0.625 mm slices in Recon 3 for the 

bone reformats. 

C. Do 2 mm by 2 mm 2D-Reformations in the coronal and sagittal planes


Smart Prep 

Prep Over 

Superior Vena Cava 

mA 

40 (Adult) 

20 (Peds) 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

10.0 2.0 50 3.0 


Neck: Vascular Mass (Part 2 Dynamic Scan) 

Adult and Peds 

Contrast (Part 2 only) 








kV 100 100 100 100 100 

mA Adults 380 300 300 300 300 

mA Peds < 6 y/o 190 150 150 150 150 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 350/20 350/20 350/20 350/20 350/20


Neck: (Add on Options) (Protocol – Adult: # 3.5 – Pediatric: # 13.5) 

Option: 

1. Puffed Cheek: 

- Do after a complete routine neck CT 

- Ask the patient to purse their lips and gently distend the cheeks with air. Practice this 

before the patient gets on the table. 

- Scan from the genu of the mandible to the EAC during this maneuver using the same 

helical scan parameters as in the routine neck CT scan. 

- No 2D-recons but use standard and bone plus algorithms 

- If there are a lot of dental fillings, also do the scans with angled views 

- Check these scans with the radiologist before the patient leaves the CT scanner 

2. Valsalva: 


- Ask the patient to take a deep breath and bear down for about 10 seconds as if they 

were having a bowel movement. Practice this before the patient gets on the table. 

- Scan from upper trachea to the angle of the mandible using the same helical scan 

parameters as in the routine neck CT scan. 



3. Vocalization: 


- Ask the patient to take a deep breath and vocalize the vowel “EEEEEEEE” for 10 

seconds during the scans. Practice this before the patient gets on the table. 

- Scan from upper trachea to the hyoid bone using the same scan parameters as in the 

routine neck CT scan. 



4. Perfusion CT: (To be monitored by Dr Gentry or Dr Hartman) 

Part 1: CT Neck without contrast 

- Use PET CT scanner unless otherwise instructed 

- Do a limited noncontrast localizing scan (ROI per radiologist) 

- Use helical mode and no gantry angle 

Part 2: CT Perfusion Study: 

- Perfusion ROI to be selected by Dr Gentry or Dr Hartman 

- 8 x 2.5 mm slices through lesion (prescribed from scout and Part 1) 

- No gantry angle 

- Cine mode with 80 KVP, 200 MA, DFOV = 18 cm, 1 rotation/sec 

- Inject 40 ml of 370 mg/ml contrast at 4 ml per sec with a 30 ml saline push 

- Begin scanning 5 seconds after the start of contrast injection 

- Scan Phases: 

- Phase 1: 1 rotation/sec at 1 sec intervals for 45 seconds 

- Phase 2: 1 rotation/sec at 15 sec intervals 7 times for 105 seconds 

- Image Processing: 

- 1 sec images reformatted to 0.5 sec images 

- Perfusion Processing: 

- Kari Pulfer to process 

- Arterial and venous input functions: ROI on the ICA and EJV 

- Measure 25-30 mm 3 freehand volumes in solid part of tumor for BV, BF, 

MTT, and CP 

Part 3: CT Neck with contrast: (optional) 

- Inject an additional 40 ml of 370 mg/ml contrast at 4 ml/sec 

- Immediately do our routine post contrast helical neck CT scan


Scan Factors for Part 2 only: CT Neck Perfusion Study 

Neck: Perfusion CT (Part 2) 

Adult & Peds 

Contrast (Part 2 only) 








kV 80 80 80 80 80 

mA Adults 250 200 200 200 200 

mA Peds < 6 y/o 130 100 100 100 100 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 350/20 350/20 350/20 350/20 350/20


Neck: (Parathyroid Adenoma) (Protocol – Adult: # 3.4 – Pediatric: # 13.4) 

Billing: 

Setup: 

DFOV: 

1. CT Neck with 

2. Contrast 

1. Patient Supine, AP and lateral scouts from sella to mid chest, no gantry angle 

2. Only do on a 64 slice scanner 



4. Remove any dentures or removable teeth; please place the shoulders as low possible 

1. Part 1: 22 cm (adults), 20 cm (peds 3-6 y/o), 18 cm (peds 0-3 y/o) 

2. Part 2: (as in routine neck CT) 

Exam: Part 1: Arterial Phase of Lower Neck 

1. Algorithm: Standard only 

2. Scan Area: Start scans at the carina and scan to the bottom of the upper teeth 

3. Contrast: Adult: 100 ml of Iohexol 300 with a 50 ml saline chase 

Peds: 1 ml/lb (2 ml/kg) of Iohexol 300 with a 10-25 ml saline chase 

4. Injection Rate: Adult: 4 ml per sec 

Peds: 2.0-2.5 ml/sec 

5. Smart Prep: Over aortic arch (initiate scan at the entry of contrast in the aortic arch) 

6. Begin Part 2: Do a routine Neck CT Protocol immediately following Part 1 with the 

following modifications. 

Part 2: Routine Neck CT with Contrast (with the following modifications) 

1. Perform a Routine Neck CT Protocol using the same scan factors as in that protocol 

2. Do not use any CT scan delay but start scanning the routine neck CT as soon as 

Part 1 is finished. 

3. Do angled views if necessary 


Part 1: A. Sagittal and coronal 2D reformations using standard algorithm images only 

Part 2: A. Adult scans: There is a soft tissue 2.5 mm slice thickness for Recon 1, a bone plus 1.25 mm slice 

thickness for Recon 2, and a soft tissue 1.25 mm slice thickness for Recon 3. Only send Recon 1 

and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 3 for the soft 

tissue reformats. Use the 1.25 mm slices in Recon 2 for the bone reformats. 

B. Pediatric scans: There is a soft tissue 1.25 mm slice thickness for Recon 1, a bone plus 1.25 mm 

slice thickness for Recon 2, and a bone plus 0.625 mm slice thickness for Recon 3. Only send 

Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 1 for 

the soft tissue reformats. Use the 0.625 mm slices in Recon 3 for the bone reformats. 

C. Do 2 mm by 2 mm 2D-Reformations in the coronal and sagittal planes


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 80 10.0 3 50 3.0 

Neck: Parathyroid Adenoma 

Adult 






20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Scan FOV Large Large Large Head Large 

kV 120 120 120 120 120 


Noise Index 11.1 11.1 11.1 11.1 11.1 

(Manual mA) 530 320 510 480 360 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 22 22 22 22 22 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 3.0 








20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 110 


Noise Index 10.6 10.6 10.6 10.6 10.6 

(Manual mA) 490 290 470 440 330 

Recon 1: 

DFOV 20 20 20 20 20 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 20 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 3.0 








20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 10.4 10.4 10.4 10.4 10.4 

(Manual mA) 440 260 420 400 300 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Brachial Plexus: (Routine) (Protocol – Adult: # 3.1 – Pediatric: # 13.1) 

(Feet First) (Protocol – Adult: # 3.2 – Pediatric: # 13.2) 

This protocol is the same as the routine neck CT with the following exceptions: 

Billing: 

Modifications: 

1. CT Neck without, or with, or without and with 


1. Inject the contralateral arm from the brachial plexus of interest. 

2. CT scan delay after arrival of contrast in aortic arch: 

- Adult: 15 sec (all scanners), 

- Peds: 10 sec (all scanners), 

3. DFOV: Range 26-32 cm. 

- Extend DFOV laterally to include bilateral humeral heads of the shoulders 

4. 2D Reformations in addition to standard routine neck reformations (see below)


Cervical Spine: (Adult Routine) (Protocol: # 3.5) 

Billing: 

Setup: 

DFOV: 

1. CT cervical spine without, or with, or without and with 



2. Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used. 

3. Patient Positioning: 

- Warning: Do not flex or extend the neck if there has been recent spine trauma or if 

the patient is in a c-spine trauma collar. 

- If no recent trauma, tilt the patient’s head so that a line connecting the lateral 

canthus of the eye and the EAC is perpendicular to the CT tabletop. 

- The shoulders should be pulled down as much as possible 

4. Scan from the top of the sella to the bottom of T2 


Contrast: 

1. Injection parameters: 

2. Volume: 100 ml of 240 mg/ml nonionic contrast (use 150ml of 240mg/ml if a CT of the 

head will also be obtained). 

3. Injection Rate: Adults: 3.5 ml/sec 


5. CT scan delay after arrival of contrast in aortic arch: 10 sec (8 slice scanners), 

15 sec (16 slice scanners), 20 sec (64 slice scanners) 


1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats. Do them in the 

coronal and sagittal planes. 

2. You must include the entire larynx and hyoid bone on the sagittal 2D reformats (see below) 

3. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using both 

the standard 1.25 mm images (Recon 1) AND the bone 0.625 mm images (Recon 2) 


Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series 

AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images (Recon 2) from the 

non-contrast series. 



Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 80 10.0 3.0 50 



LS Xtra, LS 16 & 16 Pro: 15.0 

LS 8: 10.0 

Cervical Spine: Routine 

Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 140 140 140 140 140 


Noise Index 16.2 16.2 16.2 16.2 16.2 

(Manual mA) 450 290 480 450 330 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 450/60 450/60 450/60 450/60 450/60 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Thoracic Spine: (Feet First) (Adult Routine) (Protocol: # 7.5) 

Thoracic Spine: (Head First) (Adult Routine) (Protocol: # 7.6) 

Billing: 

Setup: 

DFOV: 

1. CT thoracic spine without, or with, or without and with 




3. Non-contrast unless otherwise protocoled 

4. Scan from the top of C7 to the bottom of L1 

5. Post myelography patients: Please remember to roll the patient 360 degrees before 

scanning to distribute the contrast evenly in the spinal canal. 


Contrast: 


2. Volume: 100 ml of 240 mg/ml nonionic contrast (use 150ml of 240mg/ml if a CT of the 






For Large Patients: 

Increase scan time to 1.0 sec on CT1, CT3, CT4, and ER CT. 

Raise kV to 140 kV on CT2, East & RP CT. 

For VERY large patients, increase scan time to 1.0 sec and increase kV to 140 kV 

on CT1, CT3, CT4, and ER CT. 



the coronal and sagittal planes. 




Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast 

series AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images (Recon 2) 

from the non-contrast series. 



Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 80 10.0 3.0 50 



LS Xtra, LS 16 & 16 Pro: 15.0 

LS 8: 10.0 

Thoracic Spine: Routine 

Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 120 120 120 120 120 


Noise Index 14.4 14.4 14.4 14.4 14.4 

(Manual mA) 330 180 320 300 180 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 450/60 450/60 450/60 450/60 450/60 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Lumbar Spine: (Adult Routine) (Protocol: # 7.1) 

Billing: 

Setup: 

DFOV: 

1. CT lumbar spine without, or with, or without and with 





4. Scan from the top of T12 to the top of S2 




Contrast: 


2. Volume: 100 ml of 240 mg/ml nonionic contrast (use 150 ml of 240 mg/ml if a CT of the 






For Large Patients: 

Increase scan time to 1.0 sec on CT1, CT3, CT4, and ER CT. 

Raise kV to 140 kV on CT2, East & RP CT. 

For VERY large patients, increase scan time to 1.0 sec and increase kV to 140 kV 

on CT1, CT3, CT4, and ER CT. 








series AND also do 2mm x 2mm reformats using the bone 0.625 mm images (Recon 2) 




Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 80 10.0 3.0 50 



LS Xtra, LS 16 & 16 Pro: 15.0 

LS 8: 10.0 

Lumbar Spine: Routine 

Adult 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 120 120 120 120 120 


Noise Index 14.4 14.4 14.4 14.4 14.4 

(Manual mA) 330 180 320 300 180 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 450/60 450/60 450/60 450/60 450/60 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Cervical Spine: (Pediatric Routine) (Protocol: # 13.5) 

Billing: 

Setup: 

DFOV: 

1. CT cervical spine without, or with, or without and with 




3. Patient Positioning: 

- Warning: Do not flex or extend the neck if there has been recent spine trauma or if 

the patient is in a c-spine trauma collar. 

- If no recent trauma, tilt the patient’s head so that a line connecting the lateral 

canthus of the eye and the EAC is perpendicular to the CT tabletop. 

- The shoulders should be pulled down as much as possible 

4. Scan from the top of the sella to the bottom of T2 


scanning in order to distribute the contrast evenly in the spinal canal. 


Contrast: 


2. Volume: 1 ml/lb (2 ml/kg) of 240 non-ionic contrast. 

3. Injection Rate: 2 ml/sec 


5. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanners), 





2. You must include the entire larynx and hyoid bone on the sagittal 2D reformats (see 

below) 












Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 40 10.0 3.0 50 



LS Xtra, LS 16 & 16 Pro: 8.0 

LS 8: 5.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 120 120 120 120 120 


Noise Index 14.9 14.9 14.9 14.9 14.9 

(Manual mA) 420 240 400 380 270 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 450/60 450/60 450/60 450/60 450/60 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75





Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 40 10.0 3.0 50 



LS Xtra, LS 16 & 16 Pro: 8.0 

LS 8: 5.0 


Pediatric Infant (0 – 3yr) 






10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 14.5 14.5 14.5 14.5 14.5 

(Manual mA) 360 220 350 330 220 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 450/60 450/60 450/60 450/60 450/60 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75

Thoracic Spine: (Pediatric Routine) (Protocol: # 17.5) 


Billing: 

Setup: 

DFOV: 

1. CT thoracic spine without, or with, or without and with 





4. Scan from the top of C7 to the bottom of L1 




Contrast: 





5. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanners), 


Patient Age: 


















Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 40 10.0 3.0 50 



LS Xtra, LS 16 & 16 Pro: 8.0 

LS 8: 5.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Scan FOV Large Large Large Medium Body Large 

kV 100 100 100 100 100 


Noise Index 12.8 12.8 12.8 12.8 12.8 

(Manual mA) 310 190 300 280 190 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 450/60 450/60 450/60 450/60 450/60 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75





Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 40 10.0 3.0 50 



LS Xtra, LS 16 & 16 Pro: 8.0 

LS 8: 5.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Scan FOV Small Small Small Small Body Small 

kV 80 80 80 80 80 


Noise Index 11.3 11.3 11.3 11.3 11.3 

(Manual mA) 280 170 270 260 170 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 450/60 450/60 450/60 450/60 450/60 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Lumbar Spine: (Pediatric Routine) (Protocol: # 17.1) 

Billing: 

Setup: 

DFOV: 

1. CT lumbar spine without, or with, or without and with 





4. Scan from the top of T12 to the top of S2 




Contrast: 





5. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanner), 


Patient Age: 


















Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 40 10.0 3.0 50 



LS Xtra, LS 16 & 16 Pro: 8.0 

LS 8: 5.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Scan FOV Large Large Large Medium Body Large 

kV 100 100 100 100 100 


Noise Index 12.8 12.8 12.8 12.8 12.8 

(Manual mA) 310 190 300 280 190 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 450/60 450/60 450/60 450/60 450/60 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75





Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 

Aortic Arch 40 10.0 3.0 50 



LS Xtra, LS 16 & 16 Pro: 8.0 

LS 8: 5.0 








10 10 10 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Scan FOV Small Small Small Small Body Small 

kV 80 80 80 80 80 


Noise Index 11.3 11.3 11.3 11.3 11.3 

(Manual mA) 280 170 270 260 170 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 450/60 450/60 450/60 450/60 450/60 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 


Recon Option 

IQ Enhance 


Interval (mm) 0.375 0.375 0.375 0.312 

Recon 3: 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 



IQ Enhance 


Interval (mm) 0.75 0.75 0.625 0.75


Stealth (Stereotactic) Spine: (Protocol: # 7.2) 

Billing: 

Setup: 

DFOV: 

1. CT Stereotactic 


1. Patient Supine, AP and lateral scouts 



4. Scan one vertebrae above and below the vertebrae of interest. The region of interest 

should be noted on the CT request or CT protocol. 

5. Call ordering M.D. to verify levels if necessary. 

14 cm (for average patient) 

Scan Factors: 

1. Mode = Axial 

2. Rotation = 1 sec 

3. Detector Config = 1.25 @ 8i 

4. Interval = 10.0 

5. KVP = 120 

6. MA = 250 

7. Algorithm = Standard 

8 Scan FOV = Large 

9. DFOV = 14 (for average patient) 

Notes: 

1. If there is ANY patient motion, start the scan over. 

2. Do not change the DFOV, centering, or move the patient during the CT exam. 

3 Only the axial images are to be archived on the MOD that goes to the surgeon. 

4. When IV contrast is needed, wait until it is all injected before starting the scan. 

5. No bone windows are needed. 

6. No overlapping slices. 

7. Technical support is available 24 hours and day, 7 days a week at 800-595-9709.

Vascular Imaging: Stroke Deluxe: (Acute Stroke Workup) 

(Protocol – Adult: # 1.6 & 3.7 – Pediatric: # 11.16 & 11.17) 


Billing: 

Setup: 

DFOV: 

1. CT Head with and without 

2. CTA Head and Neck with contrast 

3. CT Brain Perfusion 

4. Contrast 

1. Patient Supine, AP and lateral scouts, No Gantry Tilt 

2. Extend the scouts to include the aortic arch for smart prep. 

3. 16 or 64 slice scanners only 




Exam: Part 1: 

Part 2: 

Part 3: 

Part 4: 

Routine Head CT without contrast (helical) 

CTA Head and Neck 

1. Scan Area from the top of the head to the bottom of the carina (see below) 

2. Scan direction scan from top to bottom 

3. Contrast Adult: On LS VCT 64 and LS 16 Pro: 

100 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase 

Adult: On LS 16, LS 8 and LS 4: 



4. Injection Rate Adult: 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast transit time) 


5. Smart Prep over aortic arch (initiate the scan at the entry of contrast in the aortic arch) 

CT Perfusion (see perfusion page for details) 

1. Wait at least 5 min from start of CTA contrast injection before beginning Perfusion Injection. 

2. Contrast 40 ml of 370 nonionic contrast (14.8 g Iodine) with 30 ml saline chase 

3. Injection Rate Adults: 5 ml per sec with a 5 sec prep delay 

Pediatric: 3-5 ml per sec (Depends on size of needle and age of patient) 

4. Prep Delay 5 seconds 

Routine Head CT with contrast (helical) 

1. Perform immediately after Perfusion Imaging (Part 3). No need to wait 5 min. 

Networking: 

1. ALI store, CTAW2 and CTAW3 

Post Processing: 

1. 2-D Reformation Instructions 

(Appendices 1 and 2) 

2. Perfusion Analysis (3D Lab) 

(Appendices 3 and 4) 

3. 3D Intravascular Image Analysis 

on ADW workstation 

(Do on Stent Cases)


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 80 10.0 3 50 3.0 

CTA: Stroke Deluxe 

Adult 






20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 120 120 120 120 120 


Noise Index 11.1 11.1 11.1 11.1 11.1 

(Manual mA) 530 320 510 480 360 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 22 22 22 22 22 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 3.0 

CTA: Stroke Deluxe: 







20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 110 


Noise Index 10.6 10.6 10.6 10.6 10.6 

(Manual mA) 490 290 470 440 330 

Recon 1: 

DFOV 20 20 20 20 20 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 20 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 3.0 

CTA: Stroke Deluxe: 







20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 10.4 10.4 10.4 10.4 10.4 

(Manual mA) 440 260 420 400 300 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Vascular Imaging: Total Cerebrovascular: (Stenosis, Trauma, Unknown Bleed) 

(Protocol – Adult: # 1.6a or 13.7a – Pediatric: # 11.16 or 11.17) 

Note: This protocol is identical to the stroke deluxe protocol.

Billing: 

Setup: 

DFOV: 


2. CTA Head with contrast 

3. CT Brain Perfusion if done 

4. Contrast used if done 


Vascular Imaging: CTA Head Only: (Stenosis, Unknown Bleed): 




3. 16 or 64 slice scanners 


the eye and the EAC is perpendicular to the CT tabletop (see below). 


Exam: Part 1: 


Part 2: 

Part 3: 

Part 4: 

Networking: 

Processing: 

CTA Head Only 

1. Scan Area from the top of the head to the bottom of C2 (see below) 


3. Contrast Adult: 80 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase 




5. Smart Prep over aortic arch (initiate the scan at the entry of contrast in the aortic arch) 


1. Wait at least 5 min from start of CTA contrast inject before beginning Perfusion Injection. 






1. If Perfusion is done, perform immediately after the Perfusion Imaging - No need to wait 5 min. 

2. If Perfusion is not done, perform scan at least 5 min after start of CTA contrast injection 


1. Thick Slab Reformat Instructions (See Appendix 1) 

2. Perfusion Analysis (3D Lab) (See Appendices 3 and 4) 

3. 3D Intravascular Image Analysis on ADW workstation (Do on Stent Cases)


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 80 10.0 3 50 3.0 

CTA: Head Only 

Adult 






20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 6.6 6.6 6.6 6.6 6.6 

(Manual mA) 620 380 600 570 420 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 450/60 450/60 450/60 450/60 450/60 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 22 22 22 22 22 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 3.0 

CTA: Head Only: 







20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 6.0 6.0 6.0 6.0 6.0 

(Manual mA) 540 330 520 490 370 

Recon 1: 

DFOV 20 20 20 20 20 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 20 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 3.0 

CTA: Head Only: 







20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 5.2 5.2 5.2 5.2 5.2 

(Manual mA) 440 290 440 410 330 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Vascular Imaging: Aneurysm (Hi-Res COW): (Nontraumatic SAH, Known Aneurysm) 


Billing: 


2. CTA Head with contrast 

3. Contrast 

Setup: 

DFOV: 18 cm 

Exam: Part 1: 

Part 2: 

Option: 

Part 3: 







CTA Head Only 

1. Scan Area From the top of the lateral ventricles to the bottom of the C2 vertebrae (use 

Part 1 to select the top slice, see below) 






5. Smart Prep Over aortic arch (initiate the scan at the entry of contrast in the aortic arch) 


1. Wait at least 5 min from start of CTA contrast inject before beginning Perfusion Injection. 






1. If Perfusion is done, perform immediately after the Perfusion Imaging - No need to wait 5 min. 

2. If Perfusion is not done, perform scan at least 5 min after start of CTA contrast injection 

Networking: 

Processing: 






Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 80 10.0 3 50 3.0 

CTA: Aneurysm (Hi-Res COW) 

Adult 






20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 6.6 6.6 6.6 6.6 6.6 

(Manual mA) 620 380 600 570 420 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 450/60 450/60 450/60 450/60 450/60 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 22 22 22 22 22 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 3.0 

CTA: Aneurysm (Hi-Res COW): 







20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 6.0 6.0 6.0 6.0 6.0 

(Manual mA) 540 330 520 490 370 

Recon 1: 

DFOV 20 20 20 20 20 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 20 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 3.0 

CTA: Aneurysm (Hi-Res COW): 







20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 5.2 5.2 5.2 5.2 5.2 

(Manual mA) 440 290 440 410 330 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Vascular Imaging: CTA Neck Only: (Cerebrovascular Disease) 


Billing: 

Setup: 

1. CTA Neck/Arch (with contrast) 

2. Contrast 

1. Patient Supine, AP and lateral scouts, no gantry tilt 




canthus of the eye and the EAC is perpendicular to the CT tabletop (see head CT 

protocol). 

Examination: CTA Neck and Arch 

1. Scan Area Start scans at the carina and scan to the EAC (see below) 

2. Scan direction Scan from bottom to top 

Networking: 

Processing: 

3. 

Contrast 

Adult: On LS VCT 64 and LS 16 Pro: 


Adult: On LS 16, LS 8 and LS 4: 



4. Injection Rate Adult: 4 ml per sec 


5. Smart Prep Over aortic arch (initiate the scan at the entry of contrast in the aortic arch) 






Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 80 10.0 3 50 3.0 

CTA: Neck Only 

Adult 






20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 120 120 120 120 120 


Noise Index 11.1 11.1 11.1 11.1 11.1 

(Manual mA) 530 320 510 480 360 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 22 22 22 22 22 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 3.0 








20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 110 


Noise Index 10.6 10.6 10.6 10.6 10.6 

(Manual mA) 490 290 470 440 330 

Recon 1: 

DFOV 20 20 20 20 20 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 20 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 3.0 








20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 10.4 10.4 10.4 10.4 10.4 

(Manual mA) 440 260 420 400 300 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75

Vascular Imaging: CT Venography: 

(Protocol – Adult: #1.9 & 3.9 – Pediatric: # 11.24 & 11.25) 


Billing: 

Setup: 


2. CTA of Head +/- CTA of Neck with contrast 

3. Contrast 





Exam: Part 1: Routine Head CT without contrast (helical) 

Part 2: CTV Head 

1. Scan Area From the top of the head to the bottom of C2 (see below) 

2. Scan direction Scan from top to bottom 



4. Injection Rate Adult: 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast 

transit time) 


5. Smart Prep Over aortic arch (initiate the scan 5 seconds after entry of contrast in 

the aortic arch) 

Part 2b: Option: CTV Head and Neck 

1. Do as in Part 2 except: 

2. Scan Area: From the top of the head to the carina 

Part 3: Routine Head CT with contrast (helical) 

1. Wait at least 5 min from start of CTV contrast injection before beginning scan.


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 80 10.0 3 50 5.0 

CT Venography 

Adult 






20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 

Scan FOV Medium Medium Medium Head Medium 

kV 120 120 120 120 120 


Noise Index 11.1 11.1 11.1 11.1 11.1 

(Manual mA) 530 280 510 480 320 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 22 22 22 22 22 


WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 5.0 

CT Venography: 







20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 100 100 100 100 100 


Noise Index 10.6 10.6 10.6 10.6 10.6 

(Manual mA) 490 260 470 440 290 

Recon 1: 

DFOV 20 20 20 20 20 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 20 20 20 20 20 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75


Smart Prep 

Prep Over 

mA 


(sec) 

Monitoring 

ISD (sec) 

Enhancement 

Threshold 


(sec) 

Aortic Arch 40 10.0 3 50 5.0 

CT Venography: 







20 20 20 20 10 


Pitch 0.562 0.562 0.562 0.531 0.625 

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25 



Interval (mm) 0.75 0.75 0.75 0.625 0.75 


kV 80 80 80 80 80 


Noise Index 10.4 10.4 10.4 10.4 10.4 

(Manual mA) 440 230 420 400 260 

Recon 1: 

DFOV 18 18 18 18 18 


WW/ WL 400/40 400/40 400/40 400/40 400/40 


Recon Option 

Recon 2: 

IQ Enhance 

DFOV 18 18 18 18 18 


WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300 


Recon Option 

Contrast 


IQ Enhance 


Interval (mm) 0.75 0.75 0.75 0.625 0.75

Appendix # 1 


CTA Head: 2D Thin and Thick Slab Reformations 

A. Do Thin 2D-Reformations through the vertebral and carotid arteries 

1. 1 mm X 1 mm right oblique sagittal (see example below) (FOV = 12) 

2. 1 mm X 1 mm left oblique sagittal (mirror image of example below) (FOV = 12) 

a. Make sure the reference line is parallel to the carotid canal (see image below) 

b. Use a window with and level of 800/200 

c. Axial images to use for obtaining the oblique sagittal 2-D Reformations 

- CTA Head Protocol: Images from C2 to the top of the lateral ventricles 

- CTA Head and Neck: Images from C2 to the top of the lateral ventricles 

d. Send to ALI Store 

B. 2D Thick-Slab MIP Reformats of Head: 

1. Choose the 1.25 mm slices 

2. Select Ref. Detail. 

3. Use a window width 600 and window level 200 

4. Choose batch. (You don’t need to change slice thickness & rendering mode on image 1st) 

5. Do axial, sagittal, and coronal thick-slab MIPs through the entire head. (See examples below) 

6. Change the slice thickness to 10 mm with an interval of 2.5 mm and change the rendering mode from 

Average to MIP. 

7. Send to ALI Store. 

8. Put the CT Angio request in the box on the wall in the E3/3 control room for the 3D to be done. 

9. All patients should have a duplicate request made, write duplicate on it, put the duplicate request in the 3D 

box, all remaining requests go to the neuro reading room.

Appendix # 2 


CTA Neck: 3D Vascular Analysis and 2D-Reformations 

A. 3D Analysis through the vertebral and carotid arteries 

1. For each carotid bifurcation, calculate the percent stenosis (NACET) using Vitrea 

2. Do 1 mm by 1 mm curved reformations through any vessel that has been previously stented 

3. Send all images to ALI Store. 

B. Do 2D-Reformations through the vertebral and carotid arteries 

1. Use an axial image near the level of the hyoid bone at the carotid bifurcation to prescribe the correct 

oblique angles. Use an image that shows the external and internal carotid arteries. 

2. Choose only the axial images from the aortic arch to the EAC. 

3. Use a window width 800 and window level 200 

4. Bilateral oblique sagittal 2D reformations: Do 2 mm X 2 mm reformations thru each carotid bifurcation. 

Angle so that the reformations go through both the external and internal carotid arteries. (See below) 

5. Coronal 2D reformations: Do 2 mm X 2 mm reformations thru both sides at the same time. Include both 

the carotid and vertebral arteries (See example below) 

6. Send to 3D Lab for Intravascular Analysis of the carotid bifurcations (i.e. severity of carotid stenosis). 

7. Send all images to ALI Store. 

8. All patients should have a duplicate request made, write duplicate on it, put the duplicate request in the 3D 

box, all remaining requests go to the neuro reading room. 

Oblique Sagittal 2D-Reformats 

Through Carotid Bifurcations 

Coronal 2D-Reformats 

Through Carotid Bifurcations

Appendix # 3 

CT Perfusion Protocol: (Specific Instructions): 


Billing: 

Setup: 

1. Perfusion and contrast used 




3. Usually done in conjunction with a CT/CTA of the Head or CT/CTA of Head/Neck 

Exam: 

DFOV: 

CT Perfusion 

1. Scan Type 

2. Cine Duration 

3. Perfusion Area 

4. Contrast 

5. Injection Rate 

patient) 

6. Prep Delay 

7. Perfusion Slabs 


Perfusion Locations: (See next Page) 

Cine 

45 seconds 

(next page) 

40 ml of 370 nonionic contrast with 30 ml saline chase 

Adult: 5 ml per sec 

Pediatric: 3-5 ml per sec (Depends on size of needle and age of 

5 seconds 

Use maximum number (4-8-16) of contiguous 5 mm slabs allowed 

by each specific CT scanner (use toggle/shuttle mode if possible) 

Perfusion Post Processing: (see Appendix 5 for further details): 

1. Prospectively reconstruct the images to .5 seconds. This is found under thick/speed - (Go 

under show recon 2). 

2. When you are in recon 2, enter the RAS coordinates manually. 

3. Network raw perfusion images to CTAW3 & ALI Source – DO Not send the perfusion part to 

ALI store 

CT Perfusion: 

Adult and Pediatric 

Contrast 



Scan Type Cine Cine Cine Cine Cine 




Cine Time Between Images 0.5 sec 0.5 sec 0.5 sec 0.5 sec 0.5 sec 


kV 80 80 80 80 80 

mA Adults 250 200 200 200 200 

mA Peds < 6 y/o 190 150 150 150 150 

Cine Duration (sec) 45 45 45 45 45 

Recon 1: 

DFOV 22 22 22 22 22 


WW/ WL 350/20 350/20 350/20 350/20 350/20


Appendix # 4: CT Perfusion Coverage 

A. 8-16 Channel CT Perfusion: 

(4 slice coverage) 

B. 64 Channel CT Perfusion: 

Non-shuttle Mode 

(8 slice coverage) 

C. 64 Channel CT Perfusion: Obtain 16 contiguous 5 mm slices from EAC Upward 

Shuttle/Toggle Mode: 

(16 slice coverage)


Appendix # 5: CT Perfusion Analysis Instructions 

Suggestions for ROI Placement

Suggestions for ROI Placement 


Continued on next page

134 Revised 7/22/09 (Gentry/Ranallo)


GE Advantage: CT Perfusion Post Processing Protocol 

a. Select Perfusion series from patient list 

b. From Applications menu at right of screen choose CT PerfusionN (exam will load) 

c. From list of protocols choose Brain Tumor 

d. Using slide bar at bottom of upper left port, slide back and forth to look for motion. If there 

is motion click apply registration, then click next. If not, click next. 

e. Now you will see a box called Processing Thresholds. Your object here is to get all little 

boxes/pixels out of the brain tissue and include as much brain parenchyma as you can. 

Your slide bar that you used to check for motion must be all the way to the left and rank 

should be 1/89. Slide air bar to left to remove boxes/pixels from ventricles and there are 

any diagonal lines with pieces missing, this air bar may fill them in. This is a very slight 

movement. Your average range should be (-27 to around -63). It can go higher and that is 

ok but usually doesn’t 

f. Slide bone bar to right to bring circle out to edge of bone only. This is easiest when using a 

bone window. Middle mouse will change window/level. Click next. 

g. Using slide bar in upper left port again, move it left to right to find a slice where contrast is 

fairly bright. Look on upper slices for anterior cerebrals, just above frontal horns. 

This is the best place to look for an artery. 

You can move up levels by right-clicking 

on your image location in your upper left port. Click on ROI to the left of your screen 

and place over an artery. Click next. This should result in a small purple circle being 

placed in an artery with a label and arrow. 

h. Now do the same for a vein. A good place to look is down in the sinus. Click next. If you 

have gone up several levels to find your vein/artery, make sure you go back to the 

beginning to place your ROIs! The vein and artery do not have to be on the same slice! 

i. Roam your image over to the right. Do this by grabbing the “ P” on the bottom of your 

upper left port (you will see a hand) and moving your head. 

j. Now place your cursor in the upper right port and hit the space bar. This will bring up a 

graph with 2 lines (1) and (2). 1 is the artery you marked and 2 is the vein. On the line that 

says “Last pre-enhancement image” grab the number and a white line will appear in your 

graph. You want to move the line to the last spot before the contrast spikes. You do this on 

line 1 only. (If you are having trouble seeing the 2 lines separately, click on the word artery 

in your upper left port. This will activate it and turn it green and you will be able to 

distinguish the two lines. When you are done click in the upper left port to de-activate the 

artery so it returns to purple.) Click next. 

k. Click compute. This will take a minute. Close Final Settings box. 

l. In the lower left port there will be a drop down menu under DFOV called Blood Flow. 

Change this view to Mean Transit Time. 

m. Click on Film/Save box and choose ROIs/Templates. Click on Neuro template for upper 

levels and Neuro-lower for lower levels (the only difference between these two is that 

Neuro-lower only has 2 ROIs to place instead of four. Hit Load. This will bring up your 

ROIs and Axis line. You may need to adjust their placement depending on your centering. 

You can now close this box. 

n. Look for any obvious perfusion abnormality. This is where you will place your ROI. If there 

isn’t any obvious abnormality then you will place your ROIs in the standard places.


o. You must straighten the Axis line by grabbing the boxes at either end to split the 

brain into two equal hemispheres. 

p. After you have done this, hold the control key down and click on all ROI’s and the axis line. 

This will turn them all green. Go back to the symmetry button and there is a little black tab, 

open that and click on that button. This will place the ROI’s on the left side. Now you are 

ready to film. 

q. In the upper left port, right mouse click and save view. 

r. In the upper right port go outside yellow box and right mouse click and save view. After 

doing that there are some numbers in red at the top and bottom left of the grid. Grab the 

numbers at the top and middle mouse scroll to the left. This should move your 1 and 2 

graph up and out of the yellow box and bring the ROI’s you just created up in view. If it 

doesn’t, you can also grab the numbers at the bottom and bring them up. Once they are in 

view right mouse click and click on multiple graphs. This will show them in a nice graph. 

s. Go out of the yellow box again and save view. 

t. Place your cursor in the lower right port and on your keyboard hit the key with the (?/). 

This will bring up all 4 views at once. Now you can film them in order without having to 

change each one. Film Mean Transit Time first, then Blood Flow, Blood Volume, and 

Permeability Surface. 

u. Go Back up to your upper left port and hold down the control key and click on your ROI’s 

to turn them green. Hit CTRL-C to copy. Go to the image location and right mouse click to 

go to the next level. This will take a minute to process. Once it is done, Hit CTRL-V to 

paste or you can also use the right click menu. 

v. Now all ROI’s will be in the same spot as before. You may need to move them just a hair if 

they get too close to bone or a big blood vessel but otherwise try to leave them in the 

same spot. 

w. Now repeat all filming. Upper left port first, upper right port next, Mean Transit Time, Blood 

Flow, Blood Volume, Permeability Surface. This time when you finish you just click on the 

next level. You don’t need to copy again because you have already done it once. If you 

move them a lot you will need to make them green again and recopy. When you get to the 

third level, CTRL-V or right click to paste your ROI’s, adjust them if necessary, then film. 

x. After you have done all four/eight levels, click on film/save. 

Choose Functional Data and 

hit save. This will bring up a graph to the right called functional data. Click next until the 

button goes gray, and go back to the film/save box and click save again. 

y. Now you can exit and go back to the patient list. Send to ALI-STORE. 

1. CTRL-C copy 

2. CTRL-V or right click menu to paste 

3. CTRL-X cut 

4. CTRL and click to make ROI’s green


Vitrea: CT Perfusion Post Processing Protocol 

a. Go to PACS and choose perfusion series. 

b. Right click 3D and choose “View selected series in Vitrea 3D”. This will launch Vitrea and 

may take a few minutes. 

c. When perfusion comes up, it will be auto-selecting your artery and vein. The amount of 

time it takes will show on the task bar at the bottom of the screen. You need to check the 

placement of both vessels. Before you do this check for rotational motion. If there is 

motion click on motion correction. This should help unless the patient picked up their head 

completely. If no motion proceed with checking artery and vein placement. If you are 

happy with the vessels selected, click compute. If not scroll to your alternate location and 

left click to draw oval over the new artery. Click artery button. Do the same for the vein. 

These do not have to be on the same slice. After you have manually selected vessels click 

compute. 

d. You will now have your 4 main images – grey scale, blood volume, blood flow and mean 

transit time. Scroll to first image and check axis line for centering. If it needs adjusting, do 

so. 

e. Click on ROI Templates, choose the one that has square ROI’s all around periphery and 2 

oval ROI’s in the center. Tight fit which is the box directly below this, should be checked. 

There is no need to adjust ROI’s. If you want to make them bigger, you can change the 

thickness. Default thickness is 15 mm and default count of ROI’s is 12. 

f. You are done except for screen saving images. 

g. Click on the camera (snap) or hit S on the keyboard. This activates the camera. Hold down 

the control key and left click in the grey-scale port (upper left hand box). Do this for all 

levels. On the bottom left task bar click back to HRS. Export all. 

Helpful hints: 

a. Wheel-roll the wheel in the middle of the mouse to go up and down levels. 

b. Window/Level-Click on the window/level button in the upper left hand side of the machine 

and left click with your mouse to change w/l. you MUST change back to ellipse when 

done. 

c. To delete something click on it to make it purple and hit delete on the keyboard. 

d. To screen save images-click on camera (snap) or hit S on the keyboard, hold down ctrl 

and left-click. This will save all four images as long as you are in upper left hand port.


Appendix: 6 

Neck CT Contrast Timing Table For Routine Neck CT 

Scanner 

(Age) 

Injection 

Rate 

Injection 

Volume 

(300 

mg/dl) 

Volume 

Saline 

Chaser 

Total 

Injection 

Volume 

CT Scan 

Delay after 

contrast 

arrival in 

arch on 

Smart Prep 

Contrast 

volume injected 

from detection 

by Smart Prep 

to Start of CT 

Scan 

Time 

available to 

scan from the 

initiation of 

the CT scans 

64 Slice 

(Adult) 

16 Slice 

(Adult) 

8 Slice 

(Adult) 

3.0 100 50 150 20 33.3 - 20 >13.3 sec 

3.0 100 50 150 15 33.3 - 15 >18.3 sec 

3.0 100 50 150 10 33.3 - 10 >23.3 sec 

64 Slice 

(Peds) 

2.0 1 ml/lb 10-25 ? 5 

Volume 

Dependant 

? 

16 Slice 

(Peds) 

2.0 1 ml/lb 10-25 ? 7 

Volume 

Dependant 

? 

8 Slice 

(Peds) 

2.0 1 ml/lb 10-25 ? 10 

Volume 

Dependant 

?

1. CTA (High-res COW) 

2. CTA (Stroke Deluxe) 

3. Temporal Bone CT 

4. Any Pediatric CT 

5. C-Spine CT 

6. T-Spine CT 

7. Orbit, Maxiface, Sinus CT 

8. Neck-Nasopharynx CT 

9. L-Spine CT 

10. Brain CT 


Appendix: 7 

64 Slice Scanner Priorities

Appendix: 8 


CT Scanner Type 

Scanner - 

Location 

# of 

Slices 

Thinnest 

Slice 

Minimum 

Scan Time 

Scanner Name 

Weight* 

Limits 

CTI – 1 16 0.625 0.4 sec 



CTI - 4 64 0.625 0.4 sec 

ER 64 0.625 0.4 sec 

CT-RP 8 1.25 0.5 sec 

East 8 1.25 0.5 sec 

LightSpeed Xtra 

(LS Xtra) 

LightSpeed 16 

(LS 16) 

LightSpeed 16 Pro 

(LS 16 Pro) 

LightSpeed VCT 64 

(LS VCT 64) 

LightSpeed VCT 64 

(LS VCT 64) 

LightSpeed 8 

(LS 8) 

LightSpeed 8 

(LS 8) 

500 

400 - 450 

400 - 450 

500 

500 

400 - 450 

400 - 450 

* When one number is given, that is the maximum allowed weight limit AND the table 

positioning accuracy at that weight limit is 0.25 mm. When two numbers are given the first 

indicates the weight limit that will provide 0.25 mm positional accuracy; the second number is 

the absolute maximum allowed weight limit and will provide a positional accuracy of 1.0 mm.


Appendix: 9 

CT Scanner Limits 

mA Limits 

Scanner Name Scan FOV 140 kV 120 kV 100 kV 80 kV 

LS VCT 64 & LS 16 Pro 

LS 16, & LS 8, 

All except Ped Head 

Ped Head 

All except Ped Head 

Ped Head 

715 800 770 675 

170 200 240 300 

380 440 420 400 

170 200 240 300 

Scan FOV 

Scanner Name 

Scan FOV 

Maximum Display 

FOV (cm) 

Default Display 

FOV (cm) 

LS VCT 

LS 16 Pro, 

LS 16, & LS 8, 

Large Body 

Medium Body 

Small Body 

Head 

Small Head 

Ped Body 

Ped Head 

Large 

Small 

Head 

Ped Head 

50 50 

50 36 

32 25 

32 25 

32 25 

32 20 

32 20 

50 50 

25 25 

25 25 

25 25

Appendix: 10 


Direction and Naming of 2D-Reformations 

1. Always do Bone 2D-Reformations before Soft Tissue 2D Reformations 

2. Always do 2D-Reformations in this order: 

a. Axial 

b. Coronal 

c. Sagittal 

d. Oblique Sagittal 

3. Always do 2D-Reformations in these directions 

a. Axial = Bottom to Top 

b. Coronal = Front to Back 

c. Sagittal = Right to Left 

d. Oblique Sagittal = Right to Left 

4. Naming of 2D-Reconstructions 

a. Axial Bone = AX BONE 

b. Coronal Bone = CO BONE 

c. Sagittal Bone = SA BONE 

d. Right Oblique Bone = RT BONE 

e. Left Oblique Bone = LT BONE 

f. Axial Soft Tissue = AX ST 

g. Coronal Soft Tissue = CO ST 

h. Sagittal Soft Tissue = SA ST 

i. Right Oblique Soft Tissue = RT ST 

j. Left Oblique Soft Tissue = LT ST 

k. TB - Right Stenver’s = RT STENV 

l. TB - Right Pöschel = RT POSCH 

m. TB - Left Stenver’s = LT STENV 

n. TB - Left Pöschel = LT POSCH 

o. CTA - Right Carotid Bifurcation = RT Car 

p. CTA - Left Carotid Bifurcation = LT Car 

q. CTA - Right ICA Oblique = RT ICA 

r. CTA - Left ICA Oblique = LT ICA


Appendix: 11 

Combined Neuro and Body Contrast Studies 

1. Split the total contrast dose equally with Body/Chest/Abdomen so that neuro has a 

total of about 50 cc of 300 mg / ml of nonionic contrast unless otherwise indicated. 

2. When the neuro CT study follows a body/chest/abdomen study, initiate the neuro CT 

scans immediately after detection of contrast on smart prep. Do not use a CT delay in 

these cases. 

3. Modify the injection parameters of the following studies for the combined studies as 

follows: (Omnipaque 300 unless otherwise specified) (Note: CTA studies will require a 

total dose of contrast that exceeds 150 ml) 

Volume (cc) 

Rate (cc/sec) 

A. CTA Head Only: 50 4 

B. CTA Head with Perfusion: (only 64 slice scanner) 

- CTA (Omnipaque 300) 40 3.3 

- Perfusion (Omnipaque 370) 40 5 

C. CTA Head & Neck: (only 64 slice scanner) 80 2.8 

D. CTA Neck Only: 50 4 

E. CT Neck: 50 3 

F. CT Orbit/Maxiface/Sinus/TB: 50 3 

G. CT Spine (C-T-L): 50 3 

H. CT Sella: 50 4 

4. Do not do the following studies as combined studies with Body/Chest/Abdomen 

unless the studies are urgent and a total of 150 cc of 300 mg/dl nonionic contrast can 

be exceeded. Ideally, the most urgent study should be performed on one day and the 

other study done on a separate day. A MRI/MRA study is an alternative when the 150 

ml total dose of contrast cannot be exceeded in a particular patient. 

A. CTA Head & Neck with Perfusion: 

- CTA (Omnipaque 300) 80 2.8 

- Perfusion (Omnipaque 370) 40 5

CT Protocols: (Brain, ENT, Spine, Vascular) - Department of Radiology

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