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Patient “must cough” several times prior to scan to clear secretions Patient imaged supine with arms elevated over head to minimize beamhardening artifact Breathing: hyperventilate x3; Take a breathe in and stop breathing Scan extends from thoracic inlet through adrenal glands Primary Scout performed in PA projection (tube at gantry bottom, patient supine) to minimize breast dose Repeat any scans with motion
kV
Siemens Sensation 64 64 x 0.6 (beam collimation 32 x 0.6) 100 (≤180 LBS) 120 (180-250 LBS) 140 (>250 LBS)
Gantry Rotation Time
0.33 sec
mAs (Reg-Lg)
40-80
Scanner effective mAs (Reg-Lg)
25-50
Detector Collimation (mm) (T)
0.6 mm
Number of active channels (N)
32
Detector configuration (N x T) Collimation (on operator console)
32 x 0.6 mm 64 x 0.6 mm
Image Sequence Table incrementation (mm/rotation) (I) Pitch ([mm/rotation]/beam collimation) (I/NT) Table Speed (mm/second) Scan Time (40 cm thorax) Nominal Reconstructed Slice Width Reconstruction Interval Reconstruction Algorithm CTDI vol (Dose in mGy) DFOV = smallest diameter of the chest wall that will completely contain the lung parenchyma as measured from the widest point of outer rib to outer rib Care Dose
1.0 mm 38.4 mm/sec 11 sec 3 mm 3 mm B40 1.9-3.8 mGy
Off”
In addition to the axial soft tissue (B40f) and lung (B60f) window reconstructions, perform the following recons: Axial MIP: Lung Window (5 x 3) (B60f) True Coronal: Soft-Tissue & Lung Window True Sagittal: Lung Window (B60f)
Chest CT Protocols Revisions Effective January 2012 Chest 2: Routine Chest CT (CECT) Chest CT alone or in combination with Abdomen/Pelvis CT Order Chest 2
Clinical Indications Any routine CECT clinical indication but in the setting of abnormal laboratory parameters (e.g., eGFR; creatinine, etc) Multiple myeloma Acute Sickle Cell Crisis Solitary Lung Nodule Follow-up Chest Wall Disease
Technologist Instructions Scan extends from thoracic inlet through adrenal glands
Patient “must cough” several times prior to scan to clear secretions Breathing: hyperventilate x3; Take a breathe in and stop breathing Repeat any scans with motion Available CXR within 1 month
Primary diagnosis of Acute Pulmonary Embolism (PE) Follow-up evaluation of previously diagnosed Pulmonary Embolism (PE) Evaluation of candidates for possible Pulmonary Thromboendartectomy Evaluation of Chronic Pulmonary Thromboembolic disease (Chronic PE) Pulmonary Arterial Hypertension (PAH) Pulmonary Arteriovenous Malformation (AVM) Technologist Instructions Available CXR same day if acute PE workup; otherwise within 1 month
Thoracic Aorta Dissection (baseline and follow-up without stent graft) Thoracic Aorta Aneurysms (baseline and follow-up without stent graft) Atheromatous disease and Penetrating Ulcers Intramural Hematoma (baseline and follow-up without stent graft) Aortitis Technologist Technique Instructions Available CXR kVp same day if acute workup; otherwise within 1 mAs month Rotation time Patient Collimation “must cough” several times if capable prior to scan to clear secretions Breathing: Slice Width hyperventilate x3; Take a breathe in and stop breathing
Thoracic Aorta Dissection (follow-up with stent graft / hardware) Thoracic Aorta Aneurysms (follow-up with stent graft / hardware) Atheromatous disease and Penetrating Ulcers (follow-up with stent graft / hardware) Intramural Hematoma (follow-up with stent graft / hardware) Technologist Instructions
Technique
Available CXR kVp same day if acute workup; otherwise within 1 mAs month Rotation time Patient Collimation “must cough” several times if capable prior to scan to clear secretions Breathing: Slice Width hyperventilate x3; Take a small breathe
1st Unenhanced
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs)
2nd Enhanced
3rd 60 sec Delay
Same
Same
0.33s 24 x 1.2mm
64 x 0.6mm
64 x 0.6mm
5.0mm
2.0mm
2.0mm
130
in and stop breathing Pitch Kernel
0.9 B40f Medium
Increments Image Sequence FOV Injection Rate
5.0mm Cr-Ca Tailored to patient N/A
Prep Time (delay)
N/A
Care Dose
“On”
Breast Shield
Appropriate patients after scout acquired Yes
PACS
0.9
0.9
B25f Smooth 1.0mm
B25f Smooth 0.7mm
4.0ml/sec 150 ml Isovue 370 + 30 ml saline chaser Bolus Tracking Trigger @ Arch at 150HU “On”
Chest CT Protocols Revisions January 2012 Chest 7: CTA Thoracic Aortography (CTA): Trauma Chest (Preference: Flash Scanner or Cardiac Gated if Non-Flash) Technologist Note: Only send 2 x 2’s to PACS (not 3 x 3’s)
Clinical Indications Unexplained Dyspnea on Exertion Suspected or Known Chronic Interstitial Lung Disease Follow-up CILD on Therapy
Technologist Instructions
Technique
1st (Soft-Tissues and Lungs)
Patient “must cough” several times prior to scan to clear secretions
kVp
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs)
Breathing: hyperventilate x3; Take a breathe in and stop breathing If patient unable to lie prone; must acquire HRCT supine with B70 kernel Repeat any scans with motion Available CXR within 1 month
2nd HRCT Sequence Supine (Inspiration) Same
3rd HRCT Sequence Prone (Inspiration) Same (Carina through Diaphragm)
mAs
130
Rotation time Collimation
0.33s 64 x 0.6mm
1mm x 2.0mm
1 x 2.0 mm
Slice Width
3.0mm
1.0mm
1.0mm
Pitch
0.75
Feed 10mm
Feed 10mm
B70s Very Sharp
B70s Very Sharp
Kernel
Increments Image
B40f Medium (soft-tissues) B60f Sharp (lungs) 3.0mm Cr-Ca
10mm Cr-Ca
10mm Cr-Ca
Sequence FOV Oral Contrast Injection Rate Prep Time (delay) Care Dose Breast Shield
Clinical Indications Suspected or Known Small Airways Disease Suspected or Known Bronchiectasis Known or Suspected GVHD Bone Marrow Transplants (pre- and post-procedure)
1st Soft-Tissues and Lungs) 100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs)
Patient “must cough” several times prior to scan to clear secretions
kVp
Breathing: hyperventilate x3; Take a small breathe in and stop breathing Repeat any Slice Width scans with motion Available CXR Pitch within 1 month Kernel
Increments
B40F Medium (soft-tissues) B70s Very Sharp 1.0 mm
B70s Very Sharp
1.0 mm
Image Sequence FOV
Cr-Ca
Tailored to patient Oral Contrast Injection N/A Rate Prep Time N/A (delay) Care Dose “On” Breast Shield Appropriate patients after scout acquired PACS Yes
Chest CT Protocols Revisions January 2012 Chest 10: Large Airways Disease-Stenosis
Chest 10
Large Airways Disease
Clinical Indications Tracheal Stenosis Bronchial Stenosis Tracheal-Esophageal Fistula Suspected Tracheal or Bronchial Injury or Fracture
Technologist Instructions
Technique
Available CXR kVp within 1 month
1st Angle of Mandible to 3rd Order Bronchi 100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs)
1st (Softtissues)
Same
mAs
130
Rotation time Collimation
0.33s 2 x 1.0 mm
24 x 1.2mm
3.0mm
3.0mm
3-5mm/sec or Pitch 1-1.6
0.75
B70s Very Sharp 1-2mm
B40F Medium 3.0mm
Patient “must cough” several times prior to scan to clear secretions Breathing: Slice Width hyperventilate x3; Take a small breathe in and stop breathing Repeat any Pitch scans with motion Kernel Increments
2nd (Lung)
3rd (Expiratory Lung)
Same
Send to TerraRecon as 3x2 for Radiologist to reconstruct
3.0mm 5.0 mm
B60F Sharp 3.0mm 5.0 mm
Image Sequence FOV
Cr-Ca
Cr-Ca
Cr-Ca
Tailored to Airway -
Same
N/A N/A
Tailored to patient 3.0ml/sec 80 ml Omni 350 30 ml saline flush 40 sec “On”
Care Dose
“On”
Appropriate patients after scout acquired Yes
Breast Shield
Appropriate patients after scout acquired Yes Yes
Oral Contrast
Injection Rate Prep Time (delay)
PACS Volume Rendering with Lung Isolation Algorithm
Yes
After scout acquired Yes
Yes
Axial MIP: Lung Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Soft-tissue Window VRT: Trachealbronchial Tree
Chest CT Protocols Revisions January 2012 Chest 11: Large Airways Disease-Malacia
3mm X 3mm Interval 2.5mm X 2.5mm Interval 1.25mm X 1.25mm Interval
Standard Lung Standard
DELAY Standard
SERIES 3 DYNAMIC BREATHING MID C4 TO DIAPHRAGM Patient should inhale to full lung capacity and begin to forcefully exhale like “blowing out a candle” during scan. Use designated “mouthpiece” COORDINATE ONSET OF SCAN ACQUISITION WITH BEGINNING OF FORCEFUL EXHALATION HELICAL 0.5SEC
RECON 1 RECON 2
3mm 3 5mm Interval 39.37 120kVp .984 :1 80 mA NOTE: TRACHEA SHOULD CHANGE IN SHAPE (ANT BOWING POST WALL OR COLLAPSE) 2.5mm X 2.5mm Interval 2.5mm X 1.25mm Interval
Standard Standard
Standard
Chest CT Protocols Revisions Effective January 2012 Designated Lung Cancer Screening Program (LCSP) Patients Only!: Chest 12: LCSP: Chest Low-Dose Helical CT (Unenhanced)
Technologist Instructions
Technique
Patient “must cough” several times prior to scan to clear secretions Patient imaged supine with arms elevated over head to minimize beamhardening artifact Breathing: hyperventilate x3; Take a breathe in and stop breathing Scan extends from thoracic inlet through adrenal glands Primary Scout performed in PA projection (tube at gantry bottom, patient supine) to minimize breast dose Repeat any scans with motion
kV
Siemens Sensation 64 64 x 0.6 (beam collimation 32 x 0.6) 120
Gantry Rotation Time
0.5 sec
mAs (Reg-Lg)
40-80
Scanner effective mAs (Reg-Lg)
25-50
Detector Collimation (mm) (T)
0.6 mm
Number of active channels (N)
32
Detector configuration (N x T) Collimation
32 x 0.6 mm 64 x 0.6 mm
(on operator console) Image Sequence Table incrementation (mm/rotation) (I) Pitch ([mm/rotation]/beam collimation) (I/NT) Table Speed (mm/second) Scan Time (40 cm thorax) Nominal Reconstructed Slice Width Reconstruction Interval Reconstruction Algorithm CTDI vol (Dose in mGy) DFOV = smallest diameter of the chest wall that will completely contain the lung parenchyma as measured from the widest point of outer rib to outer rib Care Dose Breast Shield PACS / TerraRecon/ Vitrea (for lung nodule volumetric analysis)
Cr-Ca 19.2 mm 1.0 mm 38.4 mm/sec 11 sec 2 mm 1.8 mm B30 1.9-3.8 mGy
Off” Will not be applied Yes
In addition to the axial soft tissue (B40f) and lung (B60f) window reconstructions, perform the following recons: Axial MIP: Lung Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Soft-tissue Window
