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CHEST CT PROTOCOL FOR MULTIPLE DETECTOR ROW SCANNERS

VIEWS: 9 PAGES: 5

									                                         CHEST CT PROTOCOL FOR MULTIPLE DETECTOR ROW SCANNERS

                                                                                                    (OR)
                                                         Contrast Flow    Contrast     Scam            Smart Prep   Oral
#    Study        Algorithm     Slice Thickness (mm)     Rate if          Volume       Initiation      Over         Esophageal          Field Size        Comments
                                Interval & Sequence      Excellent IV     for Avg      Time                         Contrast
                                                         Line             Size         (sec)
                                                         (cc / sec)       Patient
                                                                          (cc)
1.   Standard     Soft tissue   5x5 arch → dome              3 cc/sec        100 cc        20 sec          Aorta         +    +         As protocoled     Begin 2nd section at
     Contrasted                 5x5 thru adrenals                         Chase with                                                    or may cut off    dome of diaphragm 65
     Chest                      5x5 apex → arch + 2                          Saline                                                     some chest        seconds after beginning
                                cm                                                                                                      wall in lung      of injection on scanner
                                                                                                                                        cancer staging.   4, 75 seconds on
                                                                                                                                        Show all chest    scanner 2, 90 seconds
                                                                                                                                        wall for breast   after on Toshiba.
                                                                                                                                        cancer,
                                                                                                                                        lymphoma
2.   Standard                   5x5 arch → dome             3 cc/sec        100 cc         20 sec          Aorta          +     +       As protocoled     Begin second section at
     Contrasted                 5x5 thru abdomen                          Chase with                                for tumor abdomen   or may cut off    dome of diaphragm 65
     Chest &                    5x5 apex → arch + 2                         Saline                                                      some chest        seconds after beginning
     Abdomen                    cm                                                                                                      wall in lung      of injection on scanner
                                                                                                                                        cancer staging.   4, 75 seconds on
                                                                                                                                        Show all chest    scanner 2, 90 seconds
                                                                                                                                        wall for breast   after on Toshiba.
                                                                                                                                        cancer,
                                                                                                                                        lymphoma
3.   Standard     Soft tissue   5x5 arch → dome              3 cc/sec      100 cc          20 sec          Aorta          +     +       As protocoled     Begin 2nd section at
     Contrasted                 5x5 to crests                             Chase with                                for tumor abdomen   or may cut off    dome of diaphragm 65
     Chest,                     5x5 apex → arch + 2                         Saline                                                      some chest        seconds after beginning
     Abdomen,                   cm                                                                                                      wall in lung      of injection on scanner
     & Pelvis                   5x5 pelvis                                                                                              cancer staging.   4, 75 seconds on
                                                                                                                                        Show all chest    scanner 2, 90 seconds
                                                                                                                                        wall for breast   after on Toshiba. Pause
                                                                                                                                        cancer,           90 seconds before
                                                                                                                                        lymphoma          pelvis.
4.   Aortic       Soft tissue     5x5 apex → dome                                                                                                            1 Breath hold
     Dissection                            without IV      3 - 4 cc/sec    120 cc                          Aorta       ___    ___                            Over 300 lbs –
                                                                          Chase with                                                    Do not need to
                                                                                                                                        include entire       Toshiba preferred
                                                                            Saline                                                                           Do Not use
                                  2x2 or 2.5x2.5                                                                                        body wall.
                                                                                                                                                             Scanner 4
                                  symphysis → base
                                  of neck




                                                        Chest CT Protocol-Multi-Decector-5-2007.doc                                                             1
                                             CHEST CT PROTOCOL FOR MULTIPLE DETECTOR ROW SCANNERS

                                                                                                        (OR)
                                                             Contrast Flow    Contrast     Scam            Smart Prep      Oral
#     Study          Algorithm     Slice Thickness (mm)      Rate if          Volume       Initiation      Over            Esophageal          Field Size        Comments
                                   Interval & Sequence       Excellent IV     for Avg      Time                            Contrast
                                                             Line             Size         (sec)
                                                             (cc / sec)       Patient
                                                                              (cc)
5.    Trauma         Soft tissue   5x5 apex → dome                                                                                                                  No NG tube if
      Chest                        then…                       3 - 4 cc/sec    100 cc                            Aorta     Surgeon’s                                possible.
                                   5x5 apex → liver                           Chase with                                   discretion          As appropriate.      Go through liver
                                   inferior tip                                 Saline                                                                              even if abdomen not
                                                                                                                                                                    ordered.
                                                                                                                                                                    Sagittal & Coronal
      Trauma                                                                                                                                                        reconstructions of
      Chest                                                                                                                                                         longer pass.
      (cont’d)                                                                                                                                                      Do not use
                                                                                                                                                                    Scanner 4
6.    Trauma         Soft tissue   5x5 apex → dome                                                                                                                  No NG tube if
      Chest,                       then…                       3 - 4 cc/sec    100 cc                            Aorta     Surgeon’s           As                   possible.
      Abdomen,                     5x5 apex →                                 Chase with                                   discretion          appropriate.         Sagittal & Coronal
      & Pelvis                     symphysis                                    Saline                                                                              reconstructions of
                                                                                                                                                                    longer pass.
                                                                                                                                                                    Do not use
                                                                                                                                                                    Scanner 4
7.    Question       Soft tissue   3x3 or 3.75x3.75 base
      Subclavian,                  → apex                      3 - 4 cc/sec    100 cc          30 sec            Aorta                       May cut off       Need two passes to
      Brachio-                     Wait 30 seconds and                        Chase with                                                       some of the       differentiate flow void
      cephalic, or                 repeat carina → apex .                       Saline                                                         body wall.        from filling defect.
      SVC                                                                                                                                                            IV line in good arm
      Obstruction
8.    Chest after    Soft tissue   5x5 apex → base            Per abdominal      Per           Per                Per
      dual phase                                                  images      abdominal     abdominal          abdominal         +      +       See #1 above
      abdomen                                                                  images        images             images
9.    Chest with     Soft tissue   5x5
      oral and                                                    -----          -----          -----            -----           +      +       See #1 above
      esophageal
      only



10.   Chest after    Soft tissue   5x5 arch → dome,
      neck if                      5x5 through adrenals          3 cc/sec       70 cc          20 sec            Aorta            +     +       See #1 above
                                                                              Chase with                                      If patient can                     If > 175 cc for neck or
      <175 cc for                  5x5 apex → arch + 2
                                                                                Saline                                       swallow sitting                     if serum creatinine >
      neck                         cm
                                                                                                                                                                 1.2 mg/dl, do #9.




                                                            Chest CT Protocol-Multi-Decector-5-2007.doc                                                                2
                                              CHEST CT PROTOCOL FOR MULTIPLE DETECTOR ROW SCANNERS

                                                                                                        (OR)
                                                              Contrast Flow   Contrast     Scam            Smart Prep      Oral
#     Study          Algorithm     Slice Thickness (mm)       Rate if         Volume       Initiation      Over            Esophageal     Field Size         Comments
                                   Interval & Sequence        Excellent IV    for Avg      Time                            Contrast
                                                              Line            Size         (sec)
                                                              (cc / sec)      Patient
                                                                              (cc)
11.   Pulmonary      Soft tissue   1x1 or 2x1 or 2.5x1,                                                                       ___   ___    Cut off body
      Embolism                     Depending upon                 4 cc/sec     130 cc                          Pulmonary                   wall / for thin     Great IV,
                                   scanner and patient                        Chase with                         Artery                      sections          cooperative patient,
                                   size (thicker section                        Saline                                                                         not pregnant.
                                   for bigger patient)                                                                                    Include entire       Above 300 lbs,
      (Technologi                  base of chest → base                                                                                   body wall for        prefer Toshiba
       st chooses)                 of neck                                                                                                     5x5             Coronal
                                                                                                                                                               reconstructions
                                   Also construct as 5x5                                                                                                       If legs for Deep
                                                                                                                                                               Vein Thrombosis
                                                                                                                                                               ordered: 5x5
         (A)                                                                                                                                                   knees→ crests
                                                                                                                                                               starting 3 minutes
                                                                                                                                                               after beginning of
                                                                                                                                                               injection.
                                                                                                                                                               Do Not use
                                                                                                                                                               Scanner 4
          or
                                                                                                                              ___   ___    Cut off body
                     Soft tissue   1x1 or 2x1 dome to             4 cc/sec     150 cc                          Pulmonary                   wall / for thin     Questionable IV,
                                   roots of great vessels,                    Chase with                         Artery                      sections          question whether
                                   then base of chest to                        Saline                                                                         patient can hold
                                   base of neck on                                                                                        Include entire       breath. Mechanical
                                   Toshiba.                                                                                               body wall for        ventilation, not
         (B)                                                                                                                                    5x5            pregnant.
                                   2.5x1 dome to roots of                                                                                  (Large field        Above 300 lbs,
                                   great vessels, then                                                                                      just to find       prefer Toshiba
                                   2.5x1 back to dome.                                                                                     rare breast         Coronal
                                   Then 5x5 apex →                                                                                          mass, etc.)        reconstructions of
                                   arch, 5x5 bases on GE                                                                                                       better pass
                                                                                                                                                               If legs for Deep
                                   Also 5x5                                                                                                                    Vein Thrombosis
                                                                                                                                                               ordered: 5x5
                                                                                                                                                               knees→ crests
                                                                                                                                                               starting 3 minutes
                                                                                                                                                               after beginning of
                                                                                                                                                               injection.
                                                                                                                                                               Do Not use
                                                                                                                                                               Scanner 4



                                                             Chest CT Protocol-Multi-Decector-5-2007.doc                                                         3
                                           CHEST CT PROTOCOL FOR MULTIPLE DETECTOR ROW SCANNERS

                                                                                                     (OR)
                                                           Contrast Flow   Contrast     Scam            Smart Prep      Oral
#     Study         Algorithm     Slice Thickness (mm)     Rate if         Volume       Initiation      Over            Esophageal              Field Size        Comments
                                  Interval & Sequence      Excellent IV    for Avg      Time                            Contrast
                                                           Line            Size         (sec)
                                                           (cc / sec)      Patient
                                                                           (cc)
12.   Pulmonary     Soft tissue   1x1 or 2x1 or 2.5x1,                                                                                          As protocoled,    Coronal
      Embolism –                  depending upon               4 cc/sec     130 cc                          Pulmonary   ___         ___         or Cut off body   reconstructions.
      pregnant                    patient size (thicker                    Chase with                         Artery                            wall for thin
      women                       section for bigger                         Saline                                                             sections
                                  patient) and scanner.                                                                                         Include entire
                                  From DOME to apex.                                                                                            body wall for
                                  NO SECOND PASS.                                                                                               5x5

                                  Construct as 5x5 as
                                  well.

13.   Hemoptysis    Soft tissue   1x1 or 2x1 or 2.5x1,                                                                                          As protocoled         1 Breath hold
                                  depending on size and        4 cc/sec     130 cc           -----            Aorta           ___         ___   or include 1 cm       If prior chest
                                  scanner                                  Chase with                                                           chest wall soft       radiograph or
                                  Construct as 5x5 as                        Saline                                                             tissue outside
                                                                                                                                                                      scout view shows
                                  well.                                                                                                         of ribs.
                                                                                                                                                                      suspicious cavity
                                  From L2 → base of                                                                                             Include entire
                                  neck.                                                                                                         chest wall for        or mass or
                                                                                                                                                5x5                   consolidation,
                                                                                                                                                                      repeat cuts
                                                                                                                                                                      through this area
                                                                                                                                                                      only after 20
                                                                                                                                                                      second delay

14.   Pulmonary     Soft tissue   2x1 or 2.5x1
      Veins for                   depending on patient         3 cc/sec     130 cc                            Aorta           ___         ___   As protocoled         1 Breath hold
      electo-                     size and scanner                         Chase with                                                           or cut off body       If scout or CxR
      physiologic                 Dome → apex                                Saline                                                             wall                 normal. May do
      ablation                                                                                                                                                       without contrast
                                                                                                                                                                      Cardiologists want
                                                                                                                                                                     3-dimensional
                                                                                                                                                                     reconstructions.
                                                                                                                                                                     Send to the chest
                                                                                                                                                                     room Vitrea or
                                                                                                                                                                     Vitrea next to chest
                                                                                                                                                                     room.




                                                          Chest CT Protocol-Multi-Decector-5-2007.doc                                                                   4
                                          CHEST CT PROTOCOL FOR MULTIPLE DETECTOR ROW SCANNERS

                                                                                                      (OR)
                                                             Contrast Flow   Contrast    Scam             Smart Prep     Oral
#     Study     Algorithm     Slice Thickness (mm)           Rate if         Volume      Initiation       Over           Esophageal       Field Size        Comments
                              Interval & Sequence            Excellent IV    for Avg     Time                            Contrast
                                                             Line            Size        (sec)
                                                             (cc / sec)      Patient
                                                                             (cc)




15.   HRCT         HR         1 or 1.25mm Q 10 mm                                             ------          ------            +          As protocoled
                              prone inspiration                   ------       ------      Unless you      Unless you       Unless you    or cut off body   If patient cannot lie
                              ---------------------------                                  absolutely      absolutely       absolutely     wall. Unless     prone, do in whatever
                   HR         1 or 1.25mm Q 20 mm                                          have to use     have to use      have to use   you absolutely    position patient can lie.
                              prone expiration                                               another         another          another       have to use
                              ---------------------------                                  scanner for     scanner for      scanner for       another         Doctor may protocol
                Soft tissue   Either 1 or 9 as                                            some reason     some reason      some reason      scanner for       differently, for
                              protocoled.                                                   DO ALL          DO ALL           DO ALL        some reason        example skipping
                                                                                          HRCT’s on       HRCT’s on        HRCT’s on         DO ALL           exhalation images
                                                                                            Scanner 2       Scanner 2        Scanner 2      HRCT’s on
                                                                                                                                             Scanner 2
16.   Trachea   Soft tissue   0.5 – 1 mm thick,                                                                                           ~                 Insp ~
                              0.5 mm interval from                ------        ------       ------          ------            -----      = 20 cm                = 170 mAs
                              Hyoid (approx C4) to                                                                                                                 120 kVp
                              2 cm below carina insp
                              & exp                                                                                                                         Exp = 40 mAs
                                                                                                                                                                  120 kVp
                                                                                                                                                              Exp done while
                                                                                                                                                               patient exhales,
                              In addition construct                                                                                                            bearing down thru
                              inspiratory as 5x5,                                                                                                              entire acquisition.
                              with a field to include                                                                                                          Start scanning as
                              both lungs.                                                                                                                      patient begins to
                                                                                                                                                               exhale.
                                                                                                                                                              Practice in advance
                                                                                                                                                               with patient.
                                                                                                                                                              Send to Vitrea




                                                            Chest CT Protocol-Multi-Decector-5-2007.doc                                                           5

								
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