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

82 Revised 7/22/09 (Gentry/Ranallo)
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
6. 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).
7. Do angled views if lots of artifact from dental fillings or metal hardware
Preferred 30 cm (Range 26-30 cm)
Exam: Part 1: Limited Non-contrast CT of Neck (scan area per radiologist)
1. Standard algorithm only
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).
4. Standard algorithm only
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
Recons & Reformats:
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