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

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

radiology.wisc.edu
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06.06.2014 Views

36 Revised 7/22/09 (Gentry/Ranallo) 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 4. Patient Supine, AP and lateral scouts, no gantry angle 5. 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. 6. Use a head restraint to help the patient hold their head still. 7. Ask the patient to look straight ahead and hold their eyes in a very still position. 8. Start the scans at the infraorbital rim and scan through the top of the orbit 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 Preferred 14 cm (Range 14-16 cm) 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)

37 Revised 7/22/09 (Gentry/Ranallo) 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 2. Contrast if used 1. Patient Supine, AP and lateral scouts, no gantry angle 2. Extend the scouts to include aortic arch for smart prep. 3. Remove all metallic and high-density objects from the scanning area. 4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral 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 1. Child: (3 – 6 years) 2. Infant: (0 – 3 years) DFOV: Preferred 17.2 cm (Range 15-18 cm) Recons & Reformats: 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. 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 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.

36 Revised 7/22/09 (Gentry/Ranallo)<br />

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

Billing:<br />

Setup Info:<br />

Part 1:<br />

Part 2:<br />

DFOV:<br />

Reformats:<br />

1. <strong>CT</strong> Orbit without<br />

1. Monitored Exam: (Only scheduled and done when an <strong>ENT</strong> attending is available)<br />

2. Always obtained following a Routine Orbit <strong>CT</strong> without contrast<br />

3. Do only on 64 slice scanner<br />

4. Patient Supine, AP and lateral scouts, no gantry angle<br />

5. Patient Positioning: Tilt the patients head so that a line connecting the lateral<br />

canthus <strong>of</strong> the eye and the EAC is perpendicular to the <strong>CT</strong> tabletop (see head<br />

<strong>CT</strong> protocol). You may need to put a foam pad under the occiput to get the head<br />

in this position.<br />

6. Use a head restraint to help the patient hold their head still.<br />

7. Ask the patient to look straight ahead and hold their eyes in a very still position.<br />

8. Start the scans at the infraorbital rim and scan through the top <strong>of</strong> the orbit<br />

Routine Orbit <strong>CT</strong> without contrast<br />

- The routine orbit protocol is performed as usual<br />

- The patient must be instructed to look straight ahead prior to the scan<br />

Dynamic Maneuver<br />

- Use the routine noncontrast orbit <strong>CT</strong> scan factors<br />

- Helical 1.25 mm scans will be obtained using standard algorithm only<br />

(no bone algorithm)<br />

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

with the patient ahead <strong>of</strong> time)<br />

- Do the following scans in these directions <strong>of</strong> gaze – IN THIS ORDER:<br />

- Left gaze<br />

- Right gaze<br />

- Up gaze<br />

- Down gaze<br />

Preferred 14 cm (Range 14-16 cm)<br />

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

2. Do additional 2 x 2 mm 2D-reformations from Part 2 the as described below.<br />

- Neutral gaze: coronal and bilateral oblique sagittal recons (Part 1)<br />

- Left gaze: No 2D recons<br />

- Right gaze: No 2D recons<br />

- Up gaze: coronal and bilateral oblique sagittal recons (Part 2)<br />

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

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