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
from radiology.wisc.edu More from this publisher
06.06.2014 Views

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

83 Revised 7/22/09 (Gentry/Ranallo) 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 Scan Factors for Part 2 only: Neck: Vascular Mass (Part 2 Dynamic Scan) Adult and Peds 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

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

Smart Prep<br />

Prep Over<br />

Superior Vena Cava<br />

mA<br />

40 (Adult)<br />

20 (Peds)<br />

Monitoring Delay<br />

(sec)<br />

Monitoring<br />

ISD (sec)<br />

Enhancement<br />

Threshold<br />

Diagnostic Delay<br />

(sec)<br />

10.0 2.0 50 3.0<br />

Scan Factors for Part 2 only:<br />

Neck: <strong>Vascular</strong> Mass (Part 2 Dynamic Scan)<br />

Adult and Peds<br />

Contrast (Part 2 only)<br />

<strong>CT</strong> 1 <strong>CT</strong> 2 <strong>CT</strong> 3 <strong>CT</strong> 4 & ER <strong>CT</strong> East & RP <strong>CT</strong><br />

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS V<strong>CT</strong> 64 GE LS 8<br />

Scan Type Cine then Axial Cine then Axial Cine then Axial Cine then Axial Cine then Axial<br />

Rotation Time (sec) 1.0 1.0 1.0 1.0 1.0<br />

Detector Coverage (mm) 20 20 20 20 20<br />

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5<br />

Scan FOV Head Head Head Head Head<br />

kV 100 100 100 100 100<br />

mA Adults 380 300 300 300 300<br />

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

Recon 1:<br />

DFOV 18 18 18 18 18<br />

Recon Type Standard Standard Standard Standard Standard<br />

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

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