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

84 Revised 7/22/09 (Gentry/Ranallo)
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:
- Do after a complete routine neck CT
- 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.
- No 2D-recons but use standard and bone plus algorithms
- Check these scans with the radiologist before the patient leaves the CT scanner
3. Vocalization:
- Do after a complete routine neck CT
- 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.
- No 2D-recons but use standard and bone plus algorithms
- Check these scans with the radiologist before the patient leaves the CT scanner
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