CHEST CT PROTOCOL FOR MULTIPLE DETECTOR ROW SCANNERS

Transcription

1 1. Standard ed 2. Standard ed & Abdomen 3. Standard ed, Abdomen, & Pelvis 4. Aortic Dissection arch dome thru adrenals apex arch + 2 arch dome thru abdomen apex arch + 2 arch dome to crests apex arch + 2 pelvis apex dome without IV 2x2 or 2.5x2.5 symphysis base of neck Flow 3-4 cc/sec 120 cc Field 20 sec sec + + for tumor abdomen 20 sec + + for tumor abdomen Do not need to include entire body wall. Begin 2 nd section at after on Toshiba. Begin second section at after on Toshiba. Begin 2 nd section at after on Toshiba. Pause 90 seconds before pelvis. 300 lbs Toshiba preferred CT Protocol-Multi-Decector doc 1

2 5. Trauma Trauma (cont d) 6. Trauma, Abdomen, & Pelvis 7. Question Subclavian, Brachiocephalic, or SVC Obstruction 8. after dual phase abdomen 9. with oral and esophageal only apex dome then apex liver inferior tip apex dome then apex symphysis 3x3 or 3.75x3.75 base apex Wait 30 seconds and repeat carina apex. Flow apex base Surgeon s discretion Surgeon s discretion Field As appropriate. As appropriate. 30 sec May cut off some of the body wall. + + See #1 above See #1 above No NG tube if possible. Go through liver even if abdomen not ordered. Sagittal & Coronal longer pass. Do not use No NG tube if possible. Sagittal & Coronal longer pass. Do not use Need two passes to differentiate flow void from filling defect. IV line in good arm 10. after neck if <175 cc for neck arch dome, through adrenals apex arch cc/sec 70 cc 20 sec + + If patient can swallow sitting See #1 above If > 175 cc for neck or if serum creatinine > 1.2 mg/dl, do #9. CT Protocol-Multi-Decector doc 2

3 11. Embolism (Technologi st chooses) (A) 1x1 or 2x1 or 2.5x1, Depending upon scanner and patient size (thicker section for bigger patient) base of chest base of neck Also construct as Flow 4 cc/sec 130 cc Field Cut off body wall / for thin Great IV, cooperative patient, not pregnant. Above 300 lbs, prefer Toshiba Coronal reconstructions If legs for Deep Vein Thrombosis ordered: knees crests starting 3 minutes after beginning of injection. or (B) 1x1 or 2x1 dome to roots of great vessels, then base of chest to base of neck on Toshiba. 2.5x1 dome to roots of great vessels, then 2.5x1 back to dome. Then apex arch, bases on GE Also 4 cc/sec 150 cc Cut off body wall / for thin (Large field just to find rare breast mass, etc.) Questionable IV, question whether patient can hold breath. Mechanical ventilation, not pregnant. Above 300 lbs, prefer Toshiba Coronal better pass If legs for Deep Vein Thrombosis ordered: knees crests starting 3 minutes after beginning of injection. CT Protocol-Multi-Decector doc 3

4 12. Embolism pregnant women 1x1 or 2x1 or 2.5x1, depending upon patient size (thicker section for bigger patient) and scanner. From DOME to apex. NO SECOND PASS. Flow 4 cc/sec 130 cc Field, or Cut off body wall for thin Coronal reconstructions. Construct as as well. 13. Hemoptysis 1x1 or 2x1 or 2.5x1, depending on size and scanner Construct as as well. From L2 base of neck. 4 cc/sec 130 cc or include 1 chest wall soft tissue outside of ribs. chest wall for If prior chest radiograph or scout view shows suspicious cavity or mass or consolidation, repeat cuts through this area only after 20 second delay 14. Veins for electophysiologic ablation 2x1 or 2.5x1 depending on patient size and scanner Dome apex 3 cc/sec 130 cc or cut off body wall If scout or CxR normal. May do without contrast Cardiologists want 3-dimensional reconstructions. Send to the chest room Vitrea or Vitrea next to chest room. CT Protocol-Multi-Decector doc 4

5 Flow Field 15. HRCT HR HR 1 or 1.25mm Q 10 mm prone inspiration or 1.25mm Q 20 mm prone expiration Either 1 or 9 as protocoled. 16. Trachea mm thick, 0.5 mm interval from Hyoid (approx C4) to 2 below carina insp & exp In addition construct inspiratory as, with a field to include both lungs or cut off body wall. Unless you ~ = 20 If patient cannot lie prone, do in whatever position patient can lie. Doctor may protocol differently, for example skipping exhalation Insp ~ = 170 mas 120 kvp Exp = 40 mas 120 kvp Exp done while patient exhales, bearing down thru entire acquisition. Start scanning as patient begins to exhale. Practice in advance with patient. Send to Vitrea CT Protocol-Multi-Decector doc 5