W/ (2) (3) (4) (5) (5) (6) (6) CTA

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1 Index Abdomen W/ and W/Out (2) Abdomen Pelvis W/Out (3) Abdomen Pelvis W/ (4) Pelvis W/ (5) Chest W/Out (5) Chest/Abdomen/Pelvis W/ (6) Chest W/ (6) CTA ( 7-8) Neuro (8-9) Musculoskeletal (10) Trauma (11) Pediatrics (12-13) Guidelines (14) Patient Prep Guidelines (15-17)

2 EXAM Scan Range Scan Type/ ABDOMEN AND PELVIS EXAMS ABDOMEN W/O & W/ CONTRAST IV Contras t Scan Phase s Adrenal Pancreatic Hepatic though Iliac crest though Iliac crest though Iliac crest 2.5 x 2.5 x 2.5 x Oral Water 100 cc s 100 cc s 100 cc s (adrenals only) Portal Venous 15min (pancreas only) Portal venous (Liver only) Portal venous, coronal and Sagittal, coronal and sagittal, coronal and sagittal

3 ABDOMEN PELVIS W/O CONTRAST EXAM Scan Range Scan Type/ Scan Phase s Renal Stone/Non- Oral Only though though 2.5 x 2.5 x, coronal and Sagittal Oral, coronal and sagittal

4 ABDOMEN PELVIS W/ CONTRAST EXAM Scan Range Scan Type/ IV Scan Phase s Routine Enterography Urogram Cystogram though though though 2.5 x 2.5x 2.5 x 2.5 x Oral Volumen or Milk Water Fill Bladder via Cath 100 cc s 125 cc s 120 cc s Portal Venous 5 min delay only if trauma or suspected pyelonephriti s Portal venous *10-15 min Portal venous/ (all in one) Portal Venous, coronal and Sagittal, coronal and sagittal, coronal and sagittal, sagittal

5 PELVIS W/ CONTRAST EXAM Scan Range Scan Type/ IV Scan Phase s Routine Top of Crest 2.5 x Oral 80cc s (Preinject 40) / (all in one) Wait 5 min. to scan, coronal and Sagittal CHEST EXAMS CHEST W/O CONTRAST EXAM Scan Range Scan Type/ Scan Phase s Routine Lung Apices Adrenals x, coronal Sagittal, and MIP High Resolution Lung Apices Adrenals 1.25mm x 1i (Inspiration & Expiration-Prone Inspiration- Supine)

6 CHEST W/ CONTRAST EXAM Scan Range Scan Type/ IV Scan Phase s Routine PE Lung Apices Adrenals Lung Apices Costophrenic Angles 2.5 x 1.25 x 1.25mm 60 cc s / Pulmonary Arteries, Sagittal, and MIP, sagittal, MIP, rotational MIP CHEST/ABDOMEN/PELVIS W/ CONTRAST EXAM Scan Range Scan Type/ IV Scan Phase s Routine Lung Apices 2.5 x Oral Venous, Sagittal, and MIP

7 CTA EXAM Scan Range Scan Type/ Abdomen (Renals) Abdomen Pelvis Run-Off GI Bleed to Crest to Toes 2.5 x 2.5 x 2.5 x 2.5 x IV omni omni omni Scan Phase (graft or dissection) (graft or dissection) s, Sagittal,, sagittal,, sagittal,, sagittal,

8 Chest/ Thorax Entire Aorta CTA Head CTA NECK Apices Adrenals Apices Base of skull to Vertex Sella to Arch 1.25x x x 0.625mm 0.625x 0.625mm 75cc s 75cc s (Graft or dissection, sagittal, MIP, sagittal, Standard MIP, oblique, coronal & sagittal MIPS, sagittal, coronal All delays 5 min unless indicated or pathologically beneficial All CTA bolus timing for enhancement of Aorta/Carotids Neuro EXAM Scan Range Scan Type/ IV Scan Phase s Head W/O Skull Base to Vertex 2.5 x Standard and coronal

9 Head W/ Head W/O & W/ Stroke Facial Facial W/ Sinus Temporal Bones Neck Parathyroid Skull Base to Vertex Skull Base to Vertex Skull Base to Vertex Bone, Sagittal and Coronal Bone, Sagittal and Coronal Inferior Maxillary sinus frontal sinus Inferior Mastoid tips to top of ear Sella to Arch Sella to Arch 2.5 x 2.5 x 2.5 x x 0.625mm x 0.625mm x 0.625mm x 0.625mm 2.5 x 2.5 x 0.625x cc s Standard and coronal 60cc s omni Standard *1-5 min Standard Standard HD Bone, Sagittal and Coronal 60 cc s HD Bone, Sagittal and Pre-inject Coronal 30cc s Bone, Sagittal and Coronal 60cc s omni (Pre-Inject 30cc s) 75cc s omni Prone- Angle perpendicular to base of skull. Supine-angle parallel to base of skull Venous/- 12sec Bone Supine and Prone, Sagittal, Sagittal

10 Musculoskeletal EXAM Scan Range Scan Type/ s Shoulder Top of Shoulder scapula 2.5 x HD Bone, Sagittal, Elbow Above and Below Elbow Joint (area of interest) x 0.625mm HD Bone, Sagittal, Wrist Proximal to Radiocarpal joint mid metacarpals x Hand Entire Hand x Cervical Skull base to T x 1.25mm Thoracic C7 Thru L x 1.25mm Lumbar T1 thru S x 1.25mm Pelvis Top of Crest thru ischial 1.25 x tuberosity 1.25mm Knee Above and Below Knee Joint 1.25 x (area of interest) 1.25mm Ankle Above Ankle Thru Calcaneus x Foot Ankle Toes x HD Bone, Sagittal, HD Bone, Sagittal, Standard Bone Sagittal Standard Bone Sagittal Standard Bone Sagittal Bone, Sagittal, and Coronal HD Bone, Sagittal, HD Bone, Sagittal, HD Bone, Sagittal,

11 TRAUMA Head/C-spine/Chest/Abdomen/Pelvis EXAM Scan Range Scan Type/ IV Scan Phase s Head W/O Cervical C/A/P Skull base to Vertex Skull base to T1 Lung Apices 2.5 x 1.25 X x Standard, and coronal Standard, bone sagittal and coronal 100 cc s Portal venous 5min diaphragm bladder (if patient is stable enough), coronal and sagittal

12 Pediatrics 0-18yrs EXAM Scan Range Scan Type/ IV Scan Phase s Head W/O Craniosynostosis Chest W/ Abdomen Pelvis W/ to Crest to Apices Adrenals 5 x 5mm 1.25 x 1.25mm 5 x 5mm 5 x 5mm Oral See guideline s below Unenhan ced Unenhan ced See guideline below See guideline below Standard Standard (graft or dissection) Portal/ Venous No delays unless pathological ly indicated/be neficial, and sagittal, and sagittal,

13 Pediatric Guidelines OMNI ORAL Age Amount 1-6 mos ml 2-4oz 6-12 mos ml 4-6oz 1-4 yrs ml 6-9oz 4-8 yrs ml 9-12oz 8-12 yrs ml 12-16oz yrs ml 16-20oz >16 yrs follow adult dosing OMNI 350- IV ONLY 1.0cc per kilogram / ½ cc per pound do not exceed the adult does of 100cc

14 CT Guidelines OMNI ORAL OMNI 350- IV ONLY VISIPAQ UE IV ONLY 25ml is to be mixed with 30oz of a clear non-carbonated liquid and drank 2 hours prior to CT scan. Patients should be NPO 3 hours prior to CT scan, excluding ER and STAT patients. 350 is used for all contrast studies. Patients should be NPO 3 hours prior to CT scans. Visipaque is used for ALL cardiology patients and possible for any renal deficiency patients or allergy patients.

15 Patient Prep Guidelines Diabetics *Patients should remain off the following diabetes medications for 48 hours after IV contrast injection: Adavandament Metformin Glucophage Glucovance Creatinine/ GFR Normal creatinine levels are (results outside of the normal levels must be checked with a radiologist) Patient must also have a GFR > 45 Creatinine levels should be obtained for patients who are 65 years of age or older Diabetic Renal failure History of kidney disease Patients with a GFR between must have Renal Protection prior to CT scan. Patients with a GFR <30 CAN NOT have IV

16 Outpatient Premedication Protocol 32mg Methylprednisolone (Medrol) by mouth, night before procedure. 32mg Methylprednisolone (Medrol) by mouth 2 hrs prior to procedure and 50mg diphenhydramine (Benadryl), 1 hour before procedure. Inpatient/ ER 200mg Hydrocortisone IV, given 1 hour prior to procedure and 50 Diphenhydramine by mouth, 1 hour before procedure Unable to take by mouth 200mg Hydrocortisone IV 12 Hours before procedure, 200mg Hydrocortisone IV, 1 hour before procedure, and 50mg diphenhydramine IV, 1 hour before procedure. Renal Protection Protocol 6 Hour 1 Hour prior to procedure: Sodium Chloride 0.9% IV infuse at 3.5 ml/kg/hr Post Procedure: Sodium Chloride 0.9% IV infuse 1.18 ml/kg/hr for 6 hours. Patient s with left ventricle failure rate can not exceed 385 ml/hr (200ml/hr) 2 Hour 1 Hour prior to procedure: Sodium Chloride 0.9% IV infuse at 3.5 ml/kg/hr Post Procedure: Sodium Chloride 0.9% IV infuse 1.5 ml/kg/hr for one hour Patient s with left ventricle failure rate can not exceed 385 ml/hr (200ml/hr)

17 Post IV contrast instructions for Breastfeeding ACR (American College of Radiology) Recommends breast feeding mothers may continue breastfeeding per their usual routine ACR (American College of Radiology) specifically states because a very small percentage of iodinated contrast medium that is excreted into the breast milk and absorbed by the infant s gastrointestinal tract, we believe that the available data suggests that it is safe for the mother and infant to continue breastfeeding after such agent However, if you have any concerns with the due small percentage of iodinated contrast that may be excreted into the breast milk, bottle feeding may be substituted for breast feedings for 24 hours following administration

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