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

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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 34 Revised 7/22/09 (Gentry/Ranallo) 1. Patient Supine, AP and lateral scouts, no gantry angle 2. Extend the scouts to include aortic arch and superior vena cava for smart prep. 3. Always do exam with and without contrast 4. 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. 5. Ask the patient to look straight ahead and hold their eyes in a very still position. 6. Start the scans at the infraorbital rim and scan through the top of the orbit 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
35 Revised 7/22/09 (Gentry/Ranallo) Scan Factors for Part 2 only: (Adult and Pediatric) Smart Prep Prep Over Superior Vena Cava mA 40 (Adult) 20 (Peds) Monitoring Delay (sec) Monitoring ISD (sec) Enhancement Threshold Diagnostic Delay (sec) 10.0 2.0 50 3.0 Orbit: (Vascular Mass / Carotid-Cavernous Fistula) Adult and Pediatric Contrast (Part 2 Only) 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 Cine then Axial Cine then Axial Cine then Axial Cine then Axial Cine then Axial Rotation Time (sec) 1.0 1.0 1.0 1.0 1.0 Detector Coverage (mm) 20 20 20 20 20 Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5 Scan FOV Head Head Head Head Head 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 Recon Type Standard Standard Standard Standard Standard WW/ WL 350/20 350/20 350/20 350/20 350/20
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Vascular Imaging: Stroke Deluxe: (A
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Suggestions for ROI Placement 133 R
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1. CTA (High-res COW) 2. CTA (Strok
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CT Protocols: (Brain, ENT, Spine, Vascular) - Department of Radiology

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