Neuroradiology CT Protocols

1 Revised 7/22/09 (Gentry/Ranallo)
CT Protocols: (Brain, ENT, Spine, Vascular)

Name / MRN: ___________________ / ________________ Brain:
DOB: _______________ / Date of Scan: ______________ _____ Pediatric Brain
Protocoled By: Dr._________________________ _____ Pediatric Trauma (< 6 y/o) _____ add 3D CT
Monitored By: Dr._________________________ _____ Adult Brain

CT Tech Name & #: ________________ / ____________ _____ Pituitary & Cavernous Sinus
CT Scanner: ______________________________ _____ Stealth (Whole Brain Treatment Planning)
Contrast: Facial Trauma:

_____ Without _____ Without and Check _____ Face and Mandible (No 3D)
_____ With _____ With and Without _____ Face and Mandible (With 3D)
_____ Orbit Only (use only for blowout Fxs)

Spine:
_____ Adult _____ 3D CT (craniosynostosis, congenital facial anomaly)
_____ Pediatric (< 6 Y/O)
_____ Post-Myelogram Sinuses:
_____ Haughton Rotational _____ Pediatric Diagnostic ( < 6 y/o)
_____ Stealth: Stealth Levels ____________ _____ Adult Diagnostic
Spine Levels - Coverage _____ Follow-up Adult ENT Sinus

___ Cervical ___ Thoracic ___ Lumbar ___ Sacral Stealth (Landmarks) Only (No Longer Done per Dr Gentry)
Vascular Imaging: (CT/CTA/Perfusion) Orbit: (non-traumatic)

_____ Stroke Deluxe: (Acute Stroke Workup) _____ Routine
Includes: CTA head/neck/arch, CT perfusion, CT head w/o & w/ _____ Vascular Mass or CC-Fistula
_____ Total Cerebrovascular: (Stenosis, Trauma, Unknown Bleed) _____ With Valsalva
Includes: CTA head/neck/arch, CT perfusion, CT head w/o & w/ _____ Dynamic Multipositional
_____ CTA Head Only: (Cerebrovascular Disease, Unknown Bleed)

___ With Perfusion ___ Without Perfusion Temporal Bone: (adult or peds)
Includes: CTA head, CT head w/o & w/, +/- perfusion ____ W/O ____ W/ ____ Both ____ Vascular Mass
_____ CTA Neck Only: (Cerebrovascular Disease)

Includes: CTA neck and arch Neck – Nasopharynx – Larynx:
_____ CT Venography: _____ Head _____ Head & Neck _____ Routine
Includes: CTV head +/- neck, CT head w/o & w/ _____ Salivary Gland Calculi (W/O & W/)
_____ Aneurysm (Hi-Res COW): (Nontraumatic SAH, Known Aneurysm) _____ Vascular Mass
Includes: CTA head, CT head w/o & w/, no perfusion _____ Parathyroid Adenoma
_____ Ala Carte Studies: _____ Brachial Plexus
CTA: _____ Head _____ Neck & Arch _____ Add on Neck Options
Perfusion: _____ Yes _____ No _____ Puffed Cheek _____ Valsalva
_____ Vocalization _____ Perfusion CT
CT Perfusion (Levels – Coverage)
_____ Acute Stroke: Other Protocol:
_____ Carotid Stenosis:
_____ Posterior Fossa: (Vertebrobasilar Insufficiency)
Table of Contents:
Page # Protocol Exam
5 1.1 Adult Head – Routine Helical
8 1.2 Adult Head – Helical Scan with Angled Axial Reformations
11 1.3 Adult Head – Axial
13 11.1 & 11.2 Pediatric Head – Routine Helical
17 11.3 & 11.4 Pediatric Head – Helical Scan with Angled Axial Reformations
21 11.5 & 11.6 Pediatric Head – Axial
24 11.7 & 11.8 Pediatric Head – Trauma
27 2.1 Orbit – Routine
33 2.2 Orbit – W ith and W ithout Valsalva
34 2.3 Orbit – Vascular Mass or Carotid-Cavernous Fistula
36 2.4 Orbit – Dynamic – EOM Movements
27 12.1 &12.2 Pediatric Orbit – Routine
33 12.3 & 12.4 Pediatric Orbit – W ith and W ithout Valsalva
34 12.5 & 12.6 Pediatric Orbit – Vascular Mass or Carotid-Cavernous Fistula
36 12.7 & 12.8 Pediatric Orbit – Dynamic – EOM Movements
37 2.5a Maxillofacial Trauma – Routine
43 2.5b Maxillofacial Trauma – Routine plus 3D
37 12.9 & 12.10 Pediatric Maxillofacial Trauma – Routine
43 12.9 & 12.10 Pediatric Maxillofacial Trauma – Routine plus 3D
44 1.5 3D CT – Craniosynostosis, Congenital Facial Anomaly
44 11.9 & 11.10 Pediatric 3D CT – Craniosynostosis, Congenital Facial Anomaly
48 2.6 Pituitary Gland and Cavernous Sinus
48 12.11 & 12.12 Pediatric Pituitary Gland and Cavernous Sinus
52 1.10 Stealth – Stereotactic Head (W hole Brain Treatment Planning)
52 11.11 & 11.12 Pediatric Stealth – Stereotactic Head (W hole Brain Treatment Planning)
53 2.7 Sinuses – Diagnostic
53 12.13 & 12.14 Pediatric Sinuses – Diagnostic
59 2.8 Sinuses – Follow-up Adult ENT Sinus
61 2.9 Sinuses – Conbined Diagnostic and Landmark
61 12.16 & 12.17 Pediatric Sinuses – Conbined Diagnostic and Landmark
62 2.10 Temporal Bone and Posterior Fossa (W/O Contrast)
62 12.18 & 12.19 Pediatric Temporal Bone and Posterior Fossa (W /O Contrast)
66 2.11 Temporal Bone and Posterior Fossa (W/O and W Contrast)
66 12.20 & 12.21 Pediatric Temporal Bone and Posterior Fossa (W /O and W Contrast)
70 2.12 Temporal Bone – Vascular Mass
70 12.22 & 12.23 Pediatric Temporal Bone – Vascular Mass
75 3.1 Neck – Routine
75 3.2 Neck – Feet First
81 3.1 Neck – Salivary Gland
82 3.3 Neck – Vascular Mass
Table of Contents (continued):

Page # Protocol Exam
84 3.5 Neck – Add on Options
86 3.4 Neck – Parathyroid Adenoma
75 13.1 Pediatric Neck – Routine
75 13.2 Pediatric Neck – Feet First
81 13.1 Pediatric Neck – Salivary Gland
82 13.3 Pediatric Neck – Vascular Mass
86 3.4 Pediatric Neck – Parathyroid Adenoma
84 13.5 Pediatric Neck – Add on Options
90 3.1 Brachial Plexus – Adult
90 13.1 Brachial Plexus –Pediatric
91 3.5 Cervical Spine – Adult
93 7.5 Thoracic Spine – Feet First – Adult
94 7.6 Thoracic Spine – Head First – Adult
95 7.1 Lumbar Spine – Feet First – Adult
97 13.5 Cervical Spine – Pediatric
100 17.5 Thoracic Spine – Pediatric
103 17.1 Lumbar Spine – Pediatric
106 7.2 Stealth (Stereotactic) Spine
107 1.6 & 3.7 Vascular Imaging: Stroke Deluxe (Acute Stroke W orkup)
111 1.6a Vascular Imaging: Total Cerebrovascular
112 1.7 Vascular Imaging: CTA Head Only (Stenosis, Unknown Bleed)
116 1.8 Vascular Imaging: Aneurysm (Hi-Res COW ) (Non-traumatic SAH, Known Aneurysm)
120 3.8 Vascular Imaging: CTA Neck Only (Cerebrovascular Disease)
124 1.9 & 3.9 Vascular Imaging: CT Venography
107 11.16 & 11.17 Pediatric Vascular Imaging: Stroke Deluxe (Acute Stroke Workup)
111 11.16 & 11.17 Pediatric Vascular Imaging: Total Cerebrovascular
112 11.18 & 11.19 Pediatric Vascular Imaging: CTA Head Only (Stenosis, Unknown Bleed)
116 11.20 & 11.21 Pediatric Vascular Imaging: Aneurysm(Hi-Res COW )(Non-trauma SAH, Known Aneurysm)
120 11.22 & 11.23 Pediatric Vascular Imaging: CTA Neck Only (Cerebrovascular Disease)
124 11.24 & 11.25 Pediatric Vascular Imaging: CT Venography
128 Appendix #1 CTA Head: 2D Thin and Thick Slab Reformations
129 Appendix #2: CTA Neck: 2D-Reformations
130 Appendix #3: CT Perfusion Protocol
131 Appendix #4: CT Perfusion Coverage
132 Appendix #5: CT Perfusion Analysis Instructions
138 Appendix #6: Neck CT Contrast Timing for Routine Neck CT
139 Appendix #7: 64 Slice Scanner Prioity
140 Appendix #8: CT Scanner Type
141 Appendix #9: CT Scanner Limits
142 Appendix #10: Direction and Naming of 2D-Reformations
143 Appendix: #11 Combined Neuro and Body Contrast Studies
Scanner Nomenclature:
Scanner - # of Maximum mA Naming Convention

Scanner Name
Location Slices at 120 kV in this Protocol Book
CTI – 1 16 800 Lightspeed Xtra LS Xtra
CTI – 2 4 440 LightSpeed 16 LS 16
CTI – 3 16 800 LightSpeed 16 Pro LS 16 Pro
CTI - 4 64 800 LightSpeed VCT 64 LS VCT 64
ER 64 800 LightSpeed VCT 64 LS VCT 64
CT-RP 8 440 LightSpeed 8 LS 8
East 8 440 LightSpeed 8 LS 8

Adult Head: Routine (Helical Mode) (Protocol # 1.1)
Billing: 1. CT Head without, or with, or without and with

2. Contrast if used
Setup: 1. Supine, AP and lateral scouts, no gantry angle

2. Helical mode should be used routinely for adult head CT scans. Only use axial mode
when you cannot move the patient’s head into proper position (trauma, cervical
collar, rigid neck).
3. Patient Positioning: Tilt the patients head so that a line connecting the lateral
canthus of the eye and the EAC is perpendicular to the CT tabletop (see below). Use
axial mode and angle the gantry if you cannot place the patient’s head within 15
degrees of the proper setup angle.
4. Start scans at the bottom of C1 and scan through the top of the head
DFOV: Preferred 20 cm (Range 18-22)
Contrast: 1. 150 ml of 240 mg/dl non-ionic contrast @ 0.6 ml/sec (4.2 minutes)
2. Begin scanning as soon as contrast injection is finished
Other Info:
Head: Helical
Non-Contrast
Adult
CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT
Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8
Scan Type Helical Helical Helical Helical Helical
Rotation Time (sec) 0.5 0.6 0.4 0.4 0.7
Detector Coverage (mm)
10 10 10 20 10
Beam Collimation (mm)
Detector Rows 16 16 16 16 8
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25
Slice Thickness (mm) 5 5 5 5 5
Interval (mm) 2.5 2.5 2.5 2.5 2.5
Scan FOV Head Head Head Head Head
kV 120 120 120 120 120
Smart mA/ Auto mA Range 200-660 130-440 200-660 190-620 130-440
Noise Index 2.8 2.8 2.8 2.8 2.8
(Manual mA) 530 350 530 500 340
Recon 1:
DFOV 22 22 22 22 22
Recon Type Soft Soft Soft Soft Soft
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon Option Full Full Full Full Full
Recon 2:
DFOV 22 22 22 22 22
Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5
Interval (mm) 1.25 1.25 1.25 1.25 1.25
Head: Helical
Contrast
Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 2.5 2.5 2.5 2.5 2.5
kV 100 100 100 100 100
Noise Index 3.3 3.3 3.3 3.3 3.3
(Manual mA) 620 330 600 570 340
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 90/30 90/30 90/30 90/30 90/30
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 1.25 1.25 1.25 1.25 1.25
Adult Head: Helical Scan with Angled Axial Reformations (Protocol # 1.2)

2. Contrast if used
Setup: 1. Use this protocol when the head cannot be properly positioned for a routine helical
head scan. Example: when you cannot move the patient’s head into proper position
(trauma, cervical collar, rigid neck).
2. Supine, AP and lateral scouts, no gantry angle
3. Start the scans at C2 and scan through the top of the head
4. Do not send the source images to PACS (Only send the 2D-reformations)
5. Obtain 2D-reformations parallel to a line connecting the infraorbital rim with the
opisthion (see below). Use a sagittal view on Imageworks slightly off midline to
choose proper angle of reconstruction. Start reformations at the bottom of C1 and
go to the top of the head using a 20 cm DFOV.
6. Important: Be certain that dental filling artifact does not extend across the brain on
the helical raw data. If it does, then use the axial mode head protocol instead.
Other Info: 1. 2D-Reformations

a. Axial Soft Tissue: 5 mm thick with an interval of 2.5 mm
b. Axial Bone: 2.5 mm thick with an interval of 1.25 mm
Head: Helical Scan with Angled Axial

Non-Contrast
Reformations - Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.65 0.65 0.65 0.65 0.65
kV 120 120 120 120 120
Noise Index 5.6 5.6 5.6 5.6 5.6
(Manual mA) 440 350 420 400 340
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon Option Plus Plus Plus Full Plus
Recon Option IQ Enhance
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312 0.75

Contrast
Reformations - Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.65 0.65 0.65 0.65 0.65
kV 100 100 100 100 100
Noise Index 6.6 6.6 6.6 6.6 6.6
(Manual mA) 630 330 600 570 340
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 90/30 90/30 90/30 90/30 90/30
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.375 0.375 0.375 0.312 0.75
Adult Head: (Axial Mode) (Protocol # 1.3)

2. Contrast if used
Setup: 1. Supine, AP and lateral scouts

2. Helical mode should be used routinely `for adult head CT scans. Only use axial
mode when you cannot move the patient’s head into proper position (trauma,
cervical collar, rigid neck). This mode can also be used in unstable patients in the
emergency department when the CT scan time must be expedited.
3. Patient Positioning: Using the lateral scout image, angle the gantry so that it is
parallel to a line connecting the infraorbital rim with the opisthion (see below).
Other Info:
Head: Axial
Non-Contrast
Adult
Scan Type Axial Axial Axial Axial Axial
10 10 10 10 10
Number of Images per
2i 2i 2i 2i 2i
Rotation
kV 120 120 120 120 120
mA 670 420 630 630 420
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Head: Axial
Contrast
Adult
10 10 10 10 10
2i 2i 2i 2i 2i
Rotation
kV 100 120 100 100 120
mA 670 400 670 670 400
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 90/30 90/30 90/30 90/30 90/30
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Pediatric Head: Routine (Helical Mode) (< 6 years of age)

(Protocol # 11.1 & 11.2)

2. Contrast if used
Setup: 1. Supine, AP and lateral scouts, no gantry angle

2. Helical mode should be used routinely for pediatric head CT scans. Only use axial
cervical collar, rigid neck).
canthus of the eye and the EAC is perpendicular to the CT tabletop (see below). Use
axial mode and angle the gantry if you cannot place the patient’s head within 15
degrees of the proper setup angle.
Preferred: Preferred 16 cm (Range 14-18 cm)
Contrast: 1. 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient
1. Child: (3 – 6 years)
2. Infant: (0 – 3 years)
Other Info:
Head: Helical
Non-Contrast
Pediatric Child (3 – 6 yr)
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 2.5 2.5 2.5 2.5 2.5
Scan FOV Head Head Head Small Head Head
kV 100 100 100 100 100
Noise Index 2.6 2.6 2.6 2.6 2.6
(Manual mA) 510 340 510 480 330
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 1.25 1.25 1.25 1.25 1.25
Head: Helical
Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 2.5 2.5 2.5 2.5 2.5
kV 80 80 80 80 80
Noise Index 3.0 3.0 3.0 3.0 3.0
(Manual mA) 560 340 540 510 310
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 1.25 1.25 1.25 1.25 1.25
Head: Helical
Non-Contrast or Contrast
Pediatric Infant (0– 3 yr)
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 1.5 1.5 1.5 1.5 1.5
kV 80 80 80 80 80
Noise Index 3.3 3.3 3.3 3.3 3.3
(Manual mA) 460 260 460 430 260
Recon 1:
DFOV 20 20 20 20 20
Recon Type Standard Standard Standard Standard Standard
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon Option Plus Plus Plus Plus Plus
Recon 2:
DFOV 20 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 1.25 1.25 1.25 1.25 1.25
Pediatric Head: Helical Scan with Angled Axial Reformations (< 6 years of age)
(Protocol # 11.3 & 11.4)
2. Contrast if used
Setup: 1. Use this protocol when the head cannot be properly positioned for a routine helical
head scan. Example: when you cannot move the patient’s head into proper position
(trauma, cervical collar, rigid neck)
2. Supine, AP and lateral scouts, no gantry angle
3. Start the scans at C2 and scan through the top of the head
4. Do not send the source data to PACS (Only send the 2D-reformations)
5. Obtain 2D-reformations parallel to a line connecting the infraorbital rim with the
opisthion (see below). Start reformations at the bottom of C1 and go to the top of the
head using a 20 cm DFOV.
6. Important: Be certain that dental filling artifact does not extend across the brain on
the helical raw data. If it does, then use the axial mode head protocol instead.
DFOV: Preferred 16 cm (Range 14-18 cm)

Other Info: 1. 2D-Reformations

a. Axial Soft Tissue: 5 mm thick with an interval of 2.5 mm
b. Axial Bone: 2.5 mm with an interval of 1.25 mm

Non-Contrast
Reformations - Pediatric Child (3 – 6 yr)
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.375 0.375 0.375 0.312 0.75
kV 100 100 100 100 100
Noise Index 5.2 5.2 5.2 5.2 5.2
(Manual mA) 420 340 400 380 330
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312 0.75

Contrast
Reformations - Pediatric Child (3 – 6 yr)
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.375 0.375 0.375 0.312 0.75
kV 80 80 80 80 80
Noise Index 6.0 6.0 6.0 6.0 6.0
(Manual mA) 560 340 540 510 310
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312 0.75

Reformations - Pediatric Infant (0– 3 yr)
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.375 0.375 0.375 0.312 0.75
kV 80 80 80 80 80
Noise Index 6.6 6.6 6.6 6.6 6.6
(Manual mA) 370 260 360 340 260
Recon 1:
DFOV 20 20 20 20 20
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 20 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312 0.75
Pediatric Head: (Axial Mode) (Less than 6 years of age) (Protocol # 11.5 & 11.6)

2. Contrast if used
Setup: 1. Supine, AP and lateral scouts
2. Helical mode should be used routinely for pediatric head CT scans. Only use axial
cervical collar, rigid neck). This mode can also be used in unstable patients in the
emergency department when the CT scan time must be expedited.
3. Patient Positioning: Using the lateral scout image, angle the gantry so that it is
parallel to a line connecting the infraorbital rim with the opisthion (see below).

Other Info:
Head: Axial
Non-Contrast
10 10 10 10 10
2i 2i 2i 2i 2i
Rotation
kV 100 100 100 100 100
mA 640 420 600 600 420
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Head: Axial
Contrast
10 10 10 10 10
2i 2i 2i 2i 2i
Rotation
kV 80 100 80 80 100
mA 670 420 600 600 420
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Head: Axial
Pediatric Infant (0– 3 yr)
10 10 10 10 10
2i 2i 2i 2i 2i
Rotation
kV 80 80 80 80 80
mA 660 400 640 640 400
Recon 1:
DFOV 20 20 20 20 20
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 20 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Pediatric Head: (Trauma) (< 6 y/o) (with or without 3D CT) (Protocol # 11.7 & 11.8)
Billing: 1. CT Head without

2. 3D CT Head if done
Setup: 1. Patient Supine, AP and lateral scouts, no gantry angle

3. Remove all metallic and high-density objects from the scanning area
3. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral
canthus of the eye and the EAC is perpendicular to the CT tabletop (see below).
4. Start scans at the bottom of C1 and scan completely through the top of the head
5. Must be done with helical mode.

Contrast: 1. None
Other Info: 1. See Maxillofacial Trauma Protocol for more information on 3D reconstructions.
2. 3D Exam: Please perform three 3600 rotations at 10 0 intervals as follows
a. From a right lateral view = rotate the head horizontally for 3600
b. From an AP view = rotate vertically for 3600
c. From a W ater’s type view = rotate horizontally for 3600 (note: to get a Water’s type
projection rotate the patient’s nose upward about 200 )
3. Networking 3D images to ALI Store
4. Place the 3D request in the 3D slot on the wall in the E3/3 control room!
Head Trauma: Helical

Non-Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 2.5 2.5 2.5 2.5 2.5
kV 100 100 100 100 100
Noise Index 2.6 2.6 2.6 2.6 2.6
(Manual mA) 510 340 510 480 330
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Head Trauma: Helical

Non-Contrast
Pediatric Infant (0 – 3 yr)
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 1.5 1.5 1.5 1.5 1.5
kV 80 80 80 80 80
Noise Index 3.3 3.3 3.3 3.3 3.3
(Manual mA) 460 260 460 430 260
Recon 1:
DFOV 20 20 20 20 20
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon Option Plus Plus Plus Plus Plus
Recon 2:
DFOV 20 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Orbit: (Routine) (Protocol – Adult: # 2.1 – Pediatric: # 12.1 & 12.2)
Billing: 1. CT Orbit without, or with, or with and without

2. Contrast if used
Setup: 1. Patient Supine, AP and lateral scouts, no gantry angle.

2. Extend the scouts to include aortic arch for smart prep.
3. Patient Positioning: Tilt the patients head so that a line connecting the lateral canthus
of the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol).
You may need to put a foam pad under the occiput to get the head in this position.
4. Ask the patient to look straight ahead and hold their eyes in a very still position.
5. Start the scans at the infraorbital rim and scan through the top of the orbit
Contrast: 1. Adults: 75 ml of 240 mg/ml nonionic contrast media (use 150ml of 240mg/ml if a CT
of the head will also be obtained)
2. Pediatrics: 1 ml / pound (2 ml/kg) of 240 non-ionic contrast media
3. Injection Rate: Adults: 3 ml/sec; Pediatric: 2 ml/sec
4. Smart prep over the cavernous sinus (adults) or aortic arch (peds). Begin scanning
10 seconds (adults) or 6 seconds (pediatric) after arrival of contrast.
Recons & Reformats:

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats. Do them in
the coronal and bilateral oblique sagittal planes as shown in the image below.
2. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using
both the standard 1.25 mm images (Recon 1) AND the bone 0.625 mm images (Recon 3)
3. If this is a “with & without” contrast study: Do not do Recons 2 and 3 on the contrast scan.
Do 2D-reformats using the 1.25 mm standard algorithm images (Recon 1) only from the
contrast series AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images
from the non-contrast series (Recon 3).
4. Do not send the 0.625 mm (Recon 3) bone images to PACS.
Orbit: Routine
Non-Contrast
Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 120 120 120 120 120
Noise Index 5.6 5.6 5.6 5.6 5.6
(Manual mA) 440 350 420 400 340
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 300/0 300/0 300/0 300/0 300/0
Recon 2:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Recon 3:
DFOV 18 18 18 18
Recon Type Bone Plus Bone Plus Bone Plus Bone Plus
WW/ WL 3000/300 3000/300 3000/300 3000/300
Recon Option Plus Plus Plus Full
Slice Thickness (mm) 0.625 0.625 0.625 0.625
Interval (mm) 0.375 0.375 0.375 0.312
Smart Prep
Monitoring Delay Monitoring Enhancement Diagnostic Delay
Prep Over mA (sec) ISD (sec) Threshold (sec)
Cavernous Sinus 80 10.0 2.0 50 12.0
Orbit: Routine
Contrast
Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 6.6 6.6 6.6 6.6 6.6
(Manual mA) 620 330 600 570 340
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 350/20 350/20 350/20 350/20 350/20
Recon 2:
DFOV 18 18 18 18 18
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Recon 3:
DFOV 18 18 18 18
WW/ WL 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.375 0.375 0.375 0.312
Orbit: Routine
Non-Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 5.2 5.2 5.2 5.2 5.2
(Manual mA) 420 290 400 380 290
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 300/0 300/0 300/0 300/0 300/0
Recon 2:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Recon 3:
DFOV 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Smart Prep
Aortic Arch 40 10.0 2.0 50 6.0
Orbit: Routine
Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 6.0 6.0 6.0 6.0 6.0
(Manual mA) 510 340 460 510 340
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 300/0 300/0 300/0 300/0 300/0
Recon 2:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Recon 3:
DFOV 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Smart Prep
Aortic Arch 40 10.0 2.0 50 6.0
Orbit: Routine
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 5.1 5.1 5.1 5.1 5.1
(Manual mA) 370 260 360 340 260
Recon 1:
DFOV 15 15 15 15 15
WW/ WL 300/0 300/0 300/0 300/0 300/0
Recon 2:
DFOV 15 15 15 15 15
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Recon 3:
DFOV 15 15 15 15
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Orbit: (With and Without Valsalva) (Protocol – Adult: # 2.2 – Pediatric: # 12.3 & 12.4)
Billing: 1. CT Orbit with or with and without

2. Contrast
Setup Info: 1. Monitored Exam: ENT attending or fellow

2. Patient Supine, AP and lateral scouts, no gantry angle
canthus of the eye and the EAC is perpendicular to the CT tabletop (see head
CT protocol). You may need to put a foam pad under the occiput to get the head
in this position.
7. Always done following either a routine orbit CT with contrast or a vascular mass
CT of the orbit with and without contrast
Exam: Part 1: Routine Orbit CT with contrast or Orbit Vascular Mass CT without and with contrast
Part 2: Valsalva Protocol (as below)
- Use routine orbit scan factors (but only Recon 1 – No bone images)
- To be monitored by ENT attending or ENT fellow if possible
- If there is any indication of increased intra-orbital or intra-ocular pressure, the
radiologist should 1st clear this procedure with the ordering ophthalmologist
- First rehearse the maneuver with the patient
- Ask the patient to take a deep breath and Valsalva for 15 seconds (do not do
CT scans at this point)
- Have the patient take another deep breath, then
- Do Valsalva maneuver again.
- Begin 1.25 mm helical scans through entire orbit 5 seconds after the start of
the 2nd Valsalva maneuver
- Acquire 1.25 mm helical images in axial plane using just the standard
algorithm (no bone algorithm)
Reformats: 1. Do the routine 2D orbital reformations for Part 1.

2. Do additional 2 x 2 mm 2D-reformations (soft tissue only) from the post Valsalva
images in Part 2 in the coronal and bilateral oblique sagittal planes as shown below.
Orbit: (Vascular Mass or Carotid-Cavernous Fistula)

(Protocol – Adult: # 2.3 – Pediatric: # 12.5 & 12.6)
Billing: 1. CT Orbit (with and without)
2. Contrast
2. Extend the scouts to include aortic arch and superior vena cava for smart prep.
3. Always do exam with and without contrast
in this position.
DFOV: 14 cm (14-16 cm)
Exam: Part 1: Routine Orbit CT without contrast
- Standard algorithm (Recon 1) only (no bone algorithm images & no reformats)
Part 2: Dynamic CT scans through lesion (as described below and on next page)
- Choose eight 2.5 mm slices through the mass for dynamic scans
- Smart prep over the superior vena cava
- To be monitored by ENT attending or ENT fellow if possible
- Adults: Inject 100 ml of 240mg/ml at 3.5 ml per sec (Injection time = 28.5 sec)
(note: use 150ml of 240mg/ml if a CT of the head will also be obtained)
- Pediatrics: Inject 1 ml/lb (2 ml/kg) of 240 mg/ml contrast at 2 ml per sec
- Begin scanning with the arrival of contrast in the superior vena cava
- 1 image per sec X 5 (Using Cine Mode), then 1 image every 3 sec. X 3, then 1
image every 10 seconds X 2 (5 groups using Axial Mode with a Prep Group
Delay of 2 sec and 9 sec respectively) (scan time = 34 sec).
- Use 100 kV; 300 mA for adults, 150 mA for peds less than 6 y/o.
- Allow all of the contrast to be injected then do Part 3
- no reformats or bone algorithm with Part 2, only axial standard 2.5 mm images
Part 3: Post-contrast Orbit CT
- Scan as in routine orbit “with contrast” protocol performing all 3 Recons:
standard, bone and, thin bone
Reformats: 1. Only do 2D-Reconstructions from the Part 3 contrast-enhanced images
2. Do 2 mm x 2 mm 2D-reformations using both the standard 1.25 mm images
(Recon 1) AND the bone 0.625 mm images (Recon 3) in the coronal and bilateral
oblique sagittal planes as outlined below.
3. Do not send the 0.625 mm (Recon 3) bone images to PACS
Scan Factors for Part 2 only: (Adult and Pediatric)
Smart Prep
Superior Vena 40 (Adult)
10.0 2.0 50 3.0
Cava 20 (Peds)
Orbit: (Vascular Mass / Carotid-Cavernous Fistula)

Contrast (Part 2 Only)
Adult and Pediatric
Scan Type Cine then Axial Cine then Axial Cine then Axial Cine then Axial Cine then Axial
Detector Coverage (mm) 20 20 20 20 20
kV 100 100 100 100 100
mA Adults 380 300 300 300 300
mA Peds < 6 y/o 190 150 150 150 150
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 350/20 350/20 350/20 350/20 350/20
Orbit: (Dynamic (EOM Movements) (Protocol – Adult: # 2.4 – Pediatric: # 12.7 & 12.8)
Billing: 1. CT Orbit without
Setup Info: 1. Monitored Exam: (Only scheduled and done when an ENT attending is available)
2. Always obtained following a Routine Orbit CT without contrast
3. Do only on 64 slice scanner
4. Patient Supine, AP and lateral scouts, no gantry angle
in this position.
6. Use a head restraint to help the patient hold their head still.
Part 1: Routine Orbit CT without contrast

- The routine orbit protocol is performed as usual
- The patient must be instructed to look straight ahead prior to the scan
Part 2: Dynamic Maneuver
- Use the routine noncontrast orbit CT scan factors
- Helical 1.25 mm scans will be obtained using standard algorithm only
(no bone algorithm)
- Ask the patient to hold their head still and only move their eyes (practice this
with the patient ahead of time)
- Do the following scans in these directions of gaze – IN THIS ORDER:
- Left gaze
- Right gaze
- Up gaze
- Down gaze

Reformats: 1. Do the standard 2 x 2 mm 2D-reformations for the routine orbit exam (Part 1)
2. Do additional 2 x 2 mm 2D-reformations from Part 2 the as described below.
- Neutral gaze: coronal and bilateral oblique sagittal recons (Part 1)
- Left gaze: No 2D recons
- Right gaze: No 2D recons
- Up gaze: coronal and bilateral oblique sagittal recons (Part 2)
- Down gaze: coronal and bilateral oblique sagittal recons (Part 2)
Maxillofacial Trauma: (Routine)

(Protocol – Adult: # 2.5a – Pediatric: # 12.9 & 12.10)
Billing: 1. CT Maxi-face without, or with, or with and without

2. Contrast if used

3. Remove all metallic and high-density objects from the scanning area.
canthus and the EAC is perpendicular to the CT tabletop (see head CT protocol).
5. Scanning begins just below the genu of the mandible to the top of the frontal sinuses
Contrast: 1. Routine: w/o contrast. Use the following injection parameters if done w/ contrast.
2. Adults: 100 ml of 240 mg/ml nonionic contrast (use 150ml of 240mg/ml if a CT head
will also be obtained); Pediatrics: 1 ml/lb (2 ml/kg) of 240 non-ionic contrast.
3. Injection Rate: Adults: 3.5 ml/sec; Pediatric: 2 ml/sec
4. Smart prep over the aortic arch and begin scanning 15 seconds (adults) or 8
seconds (pediatrics) after arrival of contrast in the arch
DFOV: Preferred 17.2 cm (Range 15-18 cm)
Recons & Reformats:

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats as shown in
the image below
Oblique Sagittal: Through each orbit parallel to the optic nerves.
Sagittal: Through both orbits. Be sure to include both TMJs.
Coronal: From the anterior aspect of the superior orbital rim through the
sella. Be sure to include all of the TMJ.
both the standard 1.25 mm images (Recon 1) AND the bone images (Recon 2)
3. If this is a “with & without” contrast study: Do not do Recon 2 on the contrast scan. Do
2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series
AND also do 2mm x 2mm reformats using the bone images (Recon 2) from the non-
contrast series.
Maxillofacial Trauma
Non-Contrast
Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 120 120 120 120 120
Noise Index 5.6 5.6 5.6 5.6 5.6
(Manual mA) 440 350 420 400 340
Recon 1:
DFOV 17.2 17.2 17.2 17.2 17.2
WW/ WL 400/50 400/50 400/50 400/50 400/50
Recon 2:
DFOV 17.2 17.2 17.2 17.2 17.2
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.625 0.625 0.625 0.625 0.75
Smart Prep
Aortic Arch 80 10.0 2.5 50 15.0
Maxillofacial Trauma
Contrast
Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 6.6 6.6 6.6 6.6 6.6
(Manual mA) 620 330 600 570 340
Recon 1:
DFOV 17.2 17.2 17.2 17.2 17.2
WW/ WL 450/70 450/70 450/70 450/70 450/70
Recon 2:
DFOV 17.2 17.2 17.2 17.2 17.2
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.625 0.625 0.625 0.625 0.75
Maxillofacial Trauma:
Non-Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 5.2 5.2 5.2 5.2 5.2
(Manual mA) 420 290 400 380 290
Recon 1:
DFOV 17.2 17.2 17.2 17.2 17.2
WW/ WL 400/50 400/50 400/50 400/50 400/50
Recon 2:
DFOV 17.2 17.2 17.2 17.2 17.2
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.625 0.625 0.625 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 2.5 50 8.0
Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 6.0 6.0 6.0 6.0 6.0
(Manual mA) 490 340 460 510 340
Recon 1:
DFOV 17.2 17.2 17.2 17.2 17.2
WW/ WL 400/50 400/50 400/50 400/50 400/50
Recon 2:
DFOV 17.2 17.2 17.2 17.2 17.2
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.625 0.625 0.625 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 2.5 50 8.0
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 5.1 5.1 5.1 5.1 5.1
(Manual mA) 370 260 360 340 260
Recon 1:
DFOV 17.2 17.2 17.2 17.2 17.2
WW/ WL 400/50 400/50 400/50 400/50 400/50
Recon 2:
DFOV 17.2 17.2 17.2 17.2 17.2
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.625 0.625 0.625 0.625 0.75
Maxillofacial Trauma: (Routine plus 3D)

(Protocol – Adult: # 2.5b – Pediatric: # 12.9 & 12.10)
Billing: 1. CT Maxi-face without

2. 3D CT charge

canthus and the EAC is perpendicular to the CT tabletop (see head CT protocol).
4. Scanning begins just below the genu of the mandible to the top of the frontal sinuses
Exam: Part 1: Routine Maxiface Trauma Protocol

1. Do a routine maxillofacial trauma protocol
2. Scanning begins at the bottom of the mandible to the top of the frontal sinus (get
one air scan below chin to allow the 3D to show the entire mandible without
artifacts)
Part 2: 3D Exam Post-Processing:

1. Cut away as much of the c-spine as possible
2. Please perform three 360 degree rotations at 10 degree intervals as follows
a. From a right lateral view = rotate horizontally for 360 degrees
b. From an AP view = rotate vertically for 360 degrees
c. From a Water’s type view = rotate horizontally for 360 degrees (note: to get a
Water’s type projection rotate the patient’s nose upward about 20 degrees)
Other Info: 1. Do 2 mm x 2 mm 2D-Reformations as in the routine maxifacial protocol

2. Network the 2D and 3D images to ALI Store
3. Place the 3D request in the 3D slot on the wall in the E3/3 control room!
3D CT: (Craniosynostosis, Congenital Facial Anomaly)

Billing: 1. CT Head without contrast

2. 3D CT Charge

2. Use 64 slice scanners if possible
canthus and the EAC is perpendicular to the CT tabletop. (see head CT protocol)
5. Scanning begins below the genu of the mandible all the way through the top of the
head (Get 1-2 air scans above the head and below the chin to allow the 3D program to show
the entire head and mandible without artifacts)
DFOV: Preferred 20 cm (Range 18-22 cm) Must include the entire head, face, and mandible
Contrast: 1. Only done without contrast.
Other Info: 1. Send the following source images to PACS: Recon 1: 5 mm slice thickness
standard images (2.5 mm Plus recon for infants), and Recon 2: 1.25 mm slice
thickness bone images.
3D Reconstructions:
1. Do 3D Reconstructions only from the Recon 3 thin bone images
2. Cut away as much of the c-spine as possible
3. Please perform three 360 degree rotations at 10 degree intervals as follows
a. From a right lateral view = rotate horizontally for 360 degrees
b. From an AP view = rotate vertically for 360 degrees
c. From a Water’s type view = rotate horizontally for 360 degrees (note: to get a
Water’s type projection rotate the patient’s nose upward about 20 degrees)
4. Networking all 3D images to ALI Store
5. Make sure the 3D request is placed in the 3D slot on the wall in the E3/3 control
room!

Non-Contrast
Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 2.5 2.5 2.5 2.5 2.5
kV 120 120 120 120 120
Noise Index 2.8 2.8 2.8 2.8 2.8
(Manual mA) 440 350 420 400 340
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Recon 3:
DFOV 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312

Non-Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 2.5 2.5 2.5 2.5 2.5
kV 100 100 100 100 100
Noise Index 2.6 2.6 2.6 2.6 2.6
(Manual mA) 420 290 400 380 290
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Recon 3:
DFOV 22 22 22 22
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312

Non-Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 1.5 1.5 1.5 1.5 1.5
kV 80 80 80 80 80
Noise Index 3.3 3.3 3.3 3.3 3.3
(Manual mA) 370 260 360 340 260
Recon 1:
DFOV 20 20 20 20 20
WW/ WL 80/25 80/25 80/25 80/25 80/25
Recon 2:
DFOV 20 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Recon 3:
DFOV 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Pituitary Gland and Cavernous Sinus:

Billing: 1. CT Head with and without contrast; CT Sella with contrast
2. Contrast
3. Use 64 slice scanners if possible
Exam: Part 1: CT Head Without Contrast (do as in routine CT head)
Part 2: Pituitary CT with Contrast (as outlined below)
- Use a DFOV of approximately 14 cm (include the orbit and the sella
- Perform helical axial scans between yellow lines as diagramed at bottom of page
- Use a bolus contrast injection as listed below:
1. Adults: 150 ml of 240 mg/ml nonionic contrast at 3.5 ml/sec
2. Pediatrics: 1 ml/lb (2 ml/kg) of 240 nonionic at 2.0 to 2.5 ml/sec
- Smart prep over the aortic arch and begin scanning 15 seconds (adults) or 8
seconds (pediatrics) after arrival of contrast in the arch
- Begin Part 3 when all of contrast is in.
Part 3: CT Head With Contrast (do as in routine CT head)
DFOV: Head: Preferred 20 cm (Range 18-22 cm)
Pituitary: 14 cm
For Part 2: 1. Only send the Standard 1.25 mm (Recon 1) images to PACS. Do not send the
Recon 2 bone images to PACS.
2. Do 2 mm x 2 mm 2D-reformats using both the standard 1.25 mm (Recon 1) images
AND the bone 0.625 mm (Recon 2) images as outlined below.
Scan Factors for Part 2 only:
Smart Prep
Aortic Arch 80 10.0 2.5 50 15.0
Pituitary Gland and Cavernous Sinus

Contrast
Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 6.6 6.6 6.6 6.6 6.6
(Manual mA) 620 370 600 570 370
Recon 1:
DFOV 14 14 14 14 14
WW/ WL 350/20 350/20 350/20 350/20 350/20
Recon 2:
DFOV 14 14 14 14 14
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.375 0.375 0.375 0.312 0.75
Smart Prep
Aortic Arch 40 10.0 2.5 50 8.0

Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 6.0 6.0 6.0 6.0 6.0
(Manual mA) 560 340 540 510 340
Recon 1:
DFOV 14 14 14 14 14
WW/ WL 300/0 300/0 300/0 300/0 300/0
Recon 2:
DFOV 14 14 14 14 14
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312 0.75
Smart Prep
Aortic Arch 40 10.0 2.5 50 8.0

Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 5.1 5.1 5.1 5.1 5.1
(Manual mA) 370 300 360 340 290
Recon 1:
DFOV 12 12 12 12 12
WW/ WL 300/0 300/0 300/0 300/0 300/0
Recon 2:
DFOV 12 12 12 12 12
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312 0.75
Stealth - Stereotactic Head: (Whole Brain Treatment Planning)

Billing: 1. CT Stereotactic
2. Contrast if used
Setup: 1. Patient Supine on table top

2. AP and lateral scouts
3. No gantry angle
4. Using the lasers, line up patient so that the canthomeatal line is perpendicular to
the CT table. This may require you to tilt the patients head either up on down
slightly.
5. Scan from the hard palate to the top of the head
Contrast: 1. Adult: 150 ml of 240 mg/dl non-ionic contrast @ 0.6 ml/sec (4.2 minutes)
2. Peds: 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec
Scan Factors: Mode Axial

Time 1 sec
Mode 1.25 @ 8i - Interval 10.0
KVP 120
mA 250
Algorithm Standard
SFOV Head
DFOV 22 to 25
General Notes:
1. If there is ANY patient motion, start the scan over.
2. All images should be networked to ALI Store.
3. Archive only the axial images to the MOD that goes to the surgeon.
4. Technical support is available 24 hours and day, 7 days a week at 800-595-9709.
Sinuses (Diagnostic): (Adult and Pediatric)

(Protocol – Adult: # 2.7 – Pediatric: # 12.13 &12.14)
Billing: 1. CT Sinus without, or with, or with and without
2. Contrast if used
2. Extend the scouts to include aortic arch for smart prep if the exam is to be done with
contrast.
The tip of the nose and the both zygomatic bones must be on the scan.
4. Scan from the bottom of maxillary teeth to the top of the frontal sinuses (see below)
5. Note: If the scan is protocoled as a “with contrast” scan, start the scans at the genu
of mandible
6. Use axial CT scan factors if a coronal plane scan is ordered.
Contrast: 1. Adults: 100 ml of 240 mg/ml nonionic contrast media; Pediatrics: 1 ml/lb (2 ml/kg) of
240 nonionic contrast media.
2. Injection Rate: Adults: 3.5 ml/sec; Pediatric: 0.6 to 2.5 ml/sec
3. Smart prep over the aortic arch (use cavernous sinus if arch cannot be seen) and
begin scanning 15 seconds (adults) or 8 seconds (pediatrics) after arrival of contrast
in the arch
Recons & Reformats:
1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats (see below)
Sagittal: Through both orbits. Be sure to include both TMJs.
Coronal: From the anterior aspect of the superior orbital rim through the sella. Be
sure to include all of the TMJ.
2. If this is an exam solely with contrast or solely without contrast: Do 2D reformats using both
standard 1.25 mm images (Recon 1) and the bone images (Recon 2)
3. If this is a “with & without” contrast study: Do not do Recon 2 on the contrast scan. Do 2D-
reformats using the standard 1.25 mm images (Recon 1) only from the contrast series and
also do 2 mm x 2 mm reformats using bone images (Recon 2) from the non-contrast series.
Sinuses (Diagnostic)
Non-Contrast
Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 120 120 120 120 120
Noise Index 7.2 7.2 7.2 7.2 7.2
(Manual mA) 310 250 250 240 290
Recon 1:
DFOV 14 14 14 14 14
WW/ WL 400/30 400/30 400/30 400/30 400/30
Recon 2:
DFOV 14 14 14 14 14
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.625 0.625 0.625 0.625 0.75
Smart Prep
Aortic Arch 80 10.0 2.5 50 15.0
Contrast
Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 8.5 8.5 8.5 8.5 8.5
(Manual mA) 450 360 360 340 340
Recon 1:
DFOV 14 14 14 14 14
WW/ WL 450/50 450/50 450/50 450/50 450/50
Recon 2:
DFOV 14 14 14 14 14
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.625 0.625 0.625 0.625 0.75
Non-Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 6.8 6.8 6.8 6.8 6.8
(Manual mA) 300 240 240 230 280
Recon 1:
DFOV 14 14 14 14 14
WW/ WL 400/30 400/30 400/30 400/30 400/30
Recon 2:
DFOV 14 14 14 14 14
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.625 0.625 0.625 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 2.5 50 8.0
Contrast
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 7.7 7.7 7.7 7.7 7.7
(Manual mA) 410 330 330 310 310
Recon 1:
DFOV 14 14 14 14 14
WW/ WL 400/30 400/30 400/30 400/30 400/30
Recon 2:
DFOV 14 14 14 14 14
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.625 0.625 0.625 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 2.5 50 8.0
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 6.6 6.6 6.6 6.6 6.6
(Manual mA) 280 220 220 210 250
Recon 1:
DFOV 14 14 14 14 14
WW/ WL 400/30 400/30 400/30 400/30 400/30
Recon 2:
DFOV 14 14 14 14 14
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.625 0.625 0.625 0.625 0.75
Sinuses (Follow-up Adult ENT Sinus): (Protocol: # 2.7)
Billing: 1. CT Sinus without only (never use this protocol when giving contrast)

2. Only use this protocol for ENT and allergy patients with multiple prior diagnostic
sinus CT scans
4. Scan from the bottom of maxillary teeth to the top of the frontal sinuses (see below)
Contrast: 1. Never give contrast with this protocol

Reformats: 1. Do 2 mm x 2 mm 2D-reformations using both the standard 1.25 mm images AND the
bone 0.625 mm images as shown below.
Sinuses: (Follow-up ENT)

Non-Contrast
Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 120 120 120 120 120
Noise Index 8.8 8.8 8.8 8.8 8.8
(Manual mA) 210 170 170 160 190
Recon 1:
DFOV 14 14 14 14 14
WW/ WL 400/30 400/30 400/30 400/30 400/30
Recon 2:
DFOV 14 14 14 14 14
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.625 0.625 0.625 0.625 0.75
Sinuses: (Combined Diagnostic and Landmarx): (Adult and Pediatric)

This exam is no longer done! Do a Diagnostic Sinus CT instead. If there is any

questions by referring doctors ask them to contact either Dr. Gentry or Dr. Hartman.
Temporal Bone: (W/O Contrast) (Protocol – Adult: # 2.10 – Pediatric: # 12.18 & 12.19)
Billing: 1. Temporal Bone without

2. Only use 16 and 64 slice scanners
3. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of the
eye and the EAC is perpendicular to the CT tabletop (see below).
4. Start scans at the mastoid tip and finish at the top of the petrous bone (see below)
DFOV: 1. Recon 1 and Retro Recons: Preferred 20 cm (Range 18-22 cm)

2. Recon 2 and 3 of TB: 9.6 cm
Recons & Reformats:
1. Recon 1: 2.5 mm axial images using a bone algorithm.
2. Recon 2 & 3: Obtain left and right 0.625 mm temporal bone axial images with a DFOV of 9.6 cm.
3. Perform 1 additional Retro Recons to get the following axial images of the entire scan range:
At 20 cm DFOV, standard algorithm, 2.5 mm slice thickness, 1.25 mm increment, (WW/WL:
400/30)
4. Do 1 mm by 1 mm 2D-reformats in the coronal, Stenver’s, and Pöschl planes of each temporal
bone using Recon 2 & 3 as source images (below)
Temporal Bone
Non-Contrast
Adult
Rotation Time (sec) 0.6 0.7 0.5 0.5
10 10 10 20
Detector Rows 16 16 16 16
Pitch 0.562 0.562 0.562 0.531
Speed (mm/rot) 5.625 5.625 5.625 10.62
Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625
Interval (mm) 1.25 1.25 1.25 1.25
Scan FOV Head Head Head Head
kV 120 120 120 120
Smart mA/ Auto mA Range 190-610 130-420 180-590 170-560
Noise Index 3.7 3.7 3.7 3.7
(Manual mA) 490 340 470 450
Recon 1:
DFOV 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300
Recon Option Full Full Full Full
Recon 2:
DFOV 9.6 9.6 9.6 9.6
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 9.6 9.6 9.6 9.6
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Temporal Bone
Non-Contrast
10 10 10 20
Pitch 0.562 0.562 0.562 0.531
Speed (mm/rot) 5.625 5.625 5.625 10.62
Interval (mm) 1.25 1.25 1.25 1.25
Scan FOV Head Head Head Small Head
kV 100 100 100 100
Noise Index 3.5 3.5 3.5 3.5
(Manual mA) 480 330 460 430
Recon 1:
DFOV 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300
Recon Option Full Full Full Full
Recon Option
Recon 2: 9.6 9.6 9.6 9.6
DFOV Bone Plus Bone Plus Bone Plus Bone Plus
Recon Type 3000/300 3000/300 3000/300 3000/300
WW/ WL Plus Plus Plus Full
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 9.6 9.6 9.6 9.6
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Temporal Bone
Non-Contrast
10 10 10 20
Pitch 0.562 0.562 0.562 0.531
Speed (mm/rot) 5.625 5.625 5.625 10.62
Interval (mm) 1.25 1.25 1.25 1.25
kV 80 80 80 80
Noise Index 3.4 3.4 3.4 3.4
(Manual mA) 430 290 410 380
Recon 1:
DFOV 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300
Recon Option
Recon 2: 9.6 9.6 9.6 9.6
DFOV Bone Plus Bone Plus Bone Plus Bone Plus
Recon Type 3000/300 3000/300 3000/300 3000/300
WW/ WL Full Full Full Full
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 9.6 9.6 9.6 9.6
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Temporal Bone: (W/O & W/ Contrast) or (W/ Contrast Only):

Billing: 1. CT Temporal Bone (without and with)

2. Contrast
Setup: 1. Patient Supine, AP and lateral scouts, no gantry angle:

4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of
the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol).
DFOV: 1. Posterior Fossa: Preferred 20 cm (Range 18-22 cm)

2. TB: 9.6 cm
Exam: Part 1: Temporal Bone CT Without Contrast

1. Use the same protocol as described in the Temporal Bone W/O Contrast protocol
2. This includes axial Recon 1, 2 and 3; the additional Retro recons of soft tissue and of
bone; and all the reformatted 1 x 1 cm images of the temporal bones.
Part 2: Temporal Bone Examination With Contrast

1. Inject contrast and then obtain standard algorithm 1.25 mm scans with a 0.75 mm
interval from the bottom of C1 to 1 cm above the top of temporal bone.
2. Contrast Usage: Adults: 150 ml of 240 mg/ml nonionic contrast media; Pediatrics: 1 ml/lb
(2 ml/kg) of 240 nonionic contrast media.
3. Injection Rate: Adults: 3.5 ml/sec; Pediatric: 2.0 to 2.5 ml/sec
4. Smart prep over the aortic arch and begin scanning 30 seconds (adults) or 15 seconds
(pediatrics) after arrival of contrast in the arch.
5. Reconstruct the 1.25 mm axial slices into 2 mm x 2 mm images of the posterior fossa
(axial, coronal, and sagittal) using an 18-22 cm DFOV with standard algorithm only.
Reformats:
1. Part 1: Do 1 mm by 1 mm 2D-reformats in the coronal, Stenver’s, and Pöschl planes
2. Part 2: Do 2 mm by 2 mm 2D-reformats in the axial, coronal, and sagittal planes
Exam: Temporal Bone CT With Contrast Only

1. Use the same technique as above except do Part 2 first then do Part 1 following the
contrast study.
Scan Factors: (For Part 2 Only - With Contrast)
Smart Prep
Prep Over mA
(sec) ISD (sec) Threshold (sec)
Aortic Arch 80 10.0 3 50 30.0
Temporal Bone: (W/O & W/ Contrast)

Adult
10 10 10 20
Pitch 0.562 0.562 0.562 0.531
Speed (mm/rot) 5.625 5.625 5.625 10.62
Interval (mm) 0.75 0.75 0.75 0.625
kV 100 100 100 100
Noise Index 8.8 8.8 8.8 8.8
(Manual mA) 600 370 560 530
Recon 1:
DFOV 20 20 20 20
Recon Type Standard Standard Standard Standard
WW/ WL 400/40 400/40 400/40 400/40
Smart Prep
Prep Over mA
Aortic Arch 40 10.0 2.0 50 15.0

10 10 10 20
Pitch 0.562 0.562 0.562 0.531
Speed (mm/rot) 5.625 5.625 5.625 10.62
Interval (mm) 0.75 0.75 0.75 0.625
kV 80 80 80 80
Noise Index 7.9 7.9 7.9 7.9
(Manual mA) 550 340 510 480
Recon 1:
DFOV 20 20 20 20
WW/ WL 400/40 400/40 400/40 400/40
Smart Prep
Prep Over mA
Aortic Arch 40 10.0 2.5 50 15.0

10 10 10 20
Pitch 0.562 0.562 0.562 0.531
Speed (mm/rot) 5.625 5.625 5.625 10.62
Interval (mm) 0.75 0.75 0.75 0.625
kV 80 80 80 80
Noise Index 6.8 6.8 6.8 6.8
(Manual mA) 430 290 410 380
Recon 1:
DFOV 20 20 20 20
WW/ WL 400/40 400/40 400/40 400/40
Temporal Bone: (Vascular Mass): (Protocol – Adult: # 2.11 – Pediatric: #12.20 & 12.21)
Billing: 1. CT Temporal Bone (without and with)

2. Contrast
5. The dynamic portion is a monitored exam by an ENT radiologist or ENT Fellow.
DFOV: 1. Posterior Fossa: Preferred 20 cm (Range 18-22 cm)

2 TB: 9.6 cm
Exam: Part 1: Temporal Bone CT Without Contrast

1. Use the same protocol as described in the Temporal Bone W/O Contrast protocol
2. This includes axial Recon 1, 2 and 3; the additional Retro recons of soft tissue and of
bone; and all the reformatted 1 x 1 cm images of the temporal bones.
Part 2: Dynamic Contrast Enhanced Exam Through the Vascular Mass (as described below)
1. Select eight 2.5 mm scans through the vascular mass of posterior fossa (per radiologist)
2. 1 image per sec X 5 (Using Cine Mode), then 1 image every 3 sec. X 3, then 1 image
every 10 seconds X 2 (5 groups using Axial Mode with a Prep Group Delay of 2 sec and
9 sec respectively) (scan time = 34 sec).
3. Use 100 kV; 300 mA for adults, 150 mA for peds less than 6 y/o.
4. Standard algorithm only
5. Inject Contrast: Adults: Inject 150 ml of 240mg/ml at 4.0 ml per sec (Injection time = 37.5
sec). Pediatrics: Inject 1 ml/lb (2 ml/kg) of 240 mg/ml contrast at 2 ml per sec
6. Smart prep over superior vena cava; begin scanning with arrival of contrast in the
superior vena cava
7. As soon as all contrast has been injected immediately start Part 3
Part 3: Temporal Bone Examination With Contrast

1. Inject contrast and then obtain standard algorithm 1.25 mm scans with a 0.75 mm
interval from the bottom of C1 to 1 cm above the top of temporal bone.
2. Reconstruct the 1.25 mm axial slices into 2 mm x 2 mm images of the posterior fossa
(axial, coronal, and sagittal) using an 18-22 cm DFOV with standard algorithm only.
2D Reformats:
1. Part 1: Do 1 mm by 1 mm 2D-reformations in the coronal, Stenver’s, and Pöschl planes
2. Part 3: Do 2 mm by 2 mm 2D-reformations in the axial, coronal, and sagittal planes
Scan Factors for Part 2 only: (Dynamic Contrast Enhanced Exam)
Smart Prep
Prep Over mA
Superior Vena Cava 40 10.0 2.0 50 3.0
Temporal Bone: (Vascular Mass)

Adult & Pediatric
Detector Coverage (mm) 20 20 20 20
kV 100 100 100 100
mA Adults 380 300 300 300
mA Peds < 6 y/o 190 150 150 150
Recon 1:
DFOV 20 20 20 20
WW/ WL 350/20 350/20 350/20 350/20

Adult
10 10 10 20
Pitch 0.562 0.562 0.562 0.531
Speed (mm/rot) 5.625 5.625 5.625 10.62
Interval (mm) 0.75 0.75 0.75 0.625
kV 100 100 100 100
Noise Index 8.8 8.8 8.8 8.8
(Manual mA) 600 370 560 530
Recon 1:
DFOV 20 20 20 20
WW/ WL 400/40 400/40 400/40 400/40

10 10 10 20
Pitch 0.562 0.562 0.562 0.531
Speed (mm/rot) 5.625 5.625 5.625 10.62
Interval (mm) 0.75 0.75 0.75 0.625
kV 80 80 80 80
Noise Index 7.9 7.9 7.9 7.9
(Manual mA) 550 340 510 480
Recon 1:
DFOV 20 20 20 20
WW/ WL 400/40 400/40 400/40 400/40

Pediatric Child (0 – 3yr)
10 10 10 20
Pitch 0.562 0.562 0.562 0.531
Speed (mm/rot) 5.625 5.625 5.625 10.62
Interval (mm) 0.75 0.75 0.75 0.625
kV 80 80 80 80
Noise Index 6.8 6.8 6.8 6.8
(Manual mA) 430 290 410 380
Recon 1:
DFOV 20 20 20 20
WW/ WL 400/40 400/40 400/40 400/40
Neck: (Routine) (Protocol – Adult: # 3.1 – Pediatric: # 13.1)

(Feet First) (Protocol – Adult: # 3.2 – Pediatric: # 13.2)
Billing: 1. CT Neck without, or with, or without and with

2. Contrast if used
Setup: 1. Patient supine, AP and lateral scouts from sella to mid chest, no gantry angle
3. Have the patient remove any dentures or removable teeth, please place the
shoulders as low possible
4. Start the scan at the carina and scan to the top of the orbit
canthus of the eye and the EAC is perpendicular to the CT tabletop (see head CT
protocol).
6. Do angled views at 2.5 mm 4i for 8 slices at 2 different angles if there is lots of
artifact from dental fillings or metal hardware (see below)
7. Note: see page 138 for protocol modifications if done as combined study with
body/chest/abdomen/pelvis CT)
Contrast: 1. Adults: 100 ml of 300 mg/ml nonionic contrast media, Pediatrics: 1 ml/lb (2 ml/kg) of
300 non-ionic contrast media.
2. Use a 50 ml saline chaser in adults and a 10-25 ml saline chaser in pediatrics.
3. Injection Rate: Adults: 3.0 ml/sec; Pediatric: 2.0-2.5 ml/sec
4. Smart prep over the aortic arch.
5. CT scan delay after arrival of contrast in aortic arch:
Adult: 10 sec (4-8 slice scanner), 15 sec (16 slice scanner), 20 sec (64 slice scanner)
Peds: 5 sec (4-8 slice scanner), 8 sec (16 slice scanner), and 10 sec (64 slice scanner)
Reformats and Recons:
1. For Adult scans: There is a soft tissue 2.5 mm slice thickness for Recon 1, a bone plus 1.25 mm
slice thickness for Recon 2, and a soft tissue 1.25 mm slice thickness for Recon 3. Only send
Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 3
for the soft tissue reformats. Use the 1.25 mm slices in Recon 2 for the bone reformats.
2. For Pediatric scans: There is a soft tissue 1.25 mm slice thickness for Recon 1, a bone plus
1.25 mm slice thickness for Recon 2, and a bone plus 0.625 mm slice thickness for Recon 3.
Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in
Recon 1 for the soft tissue reformats. Use the 0.625 mm slices in Recon 3 for the bone
reformats.
3. Do 2 mm by 2 mm 2D-Reformations in the coronal and sagittal planes
Smart Prep
Monitoring Delay Monitoring Enhancement
Prep Over mA (sec) ISD (sec) Threshold Diagnostic Delay (sec)
LS VCT64: 10.0
Aortic Arch 80 10.0 3.0 50 LS 16 & 16 Pro: 15.0
LS 4 & LS 8: 20.0
Neck: Routine
Adult
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 1.25 1.25 1.25 1.25 1.25
Scan FOV Large Large Large Large Body Large
kV 140 140 140 140 140
Noise Index 11.4 11.4 11.4 11.4 11.4
(Manual mA) 450 290 480 450 330
Recon 1:
DFOV 30 30 30 30 30
WW/ WL 300/35 300/35 300/35 300/35 300/35
Recon 2:
DFOV 30 30 30 30 30
WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Recon 3:
DFOV 30 30 30 30 30
WW/ WL 300/35 300/35 300/35 300/35 300/35
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
LS VCT64: 5.0
LS 4 & LS 8: 10.0
Neck: Routine
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 1.25 1.25 1.25 1.25 1.25
kV 120 120 120 120 120
Noise Index 14.9 14.9 14.9 14.9 14.9
(Manual mA) 430 240 400 380 270
Recon 1:
DFOV 26 26 26 26 26
WW/ WL 300/35 300/35 300/35 300/35 300/35
Recon 2:
DFOV 26 26 26 26 26
WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Recon 3:
DFOV 26 26 26 26 26
WW/ WL 300/35 300/35 300/35 300/35 300/35
Interval (mm) 0.375 0.375 0.375 0.312 0.75
Smart Prep
LS VCT64: 5.0
LS 4 & LS 8: 10.0
Neck: Routine
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 14.5 14.5 14.5 14.5 14.5
(Manual mA) 360 220 350 330 220
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 300/35 300/35 300/35 300/35 300/35
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Recon 3:
DFOV 22 22 22 22
WW/ WL 300/35 300/35 300/35 300/35
Interval (mm) 0.375 0.375 0.375 0.312
Neck: Routine
Adult – Angled Axials
10 10 10 10 10
4i 4i 4i 4i 4i
Rotation
kV 120 120 120 120 120
mA 640 440 720 720 440
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 300/35 300/35 300/35 300/35 300/35
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250
Neck: Routine
Pediatric Child (3 – 6 yr) – Angled Axials
10 10 10 10 10
4i 4i 4i 4i 4i
Rotation
kV 100 100 100 100 100
mA 630 420 700 700 420
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 300/35 300/35 300/35 300/35 300/35
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250
Neck: Routine
Pediatric Infant (0 – 3 yr) – Angled Axials
10 10 10 10 10
4i 4i 4i 4i 4i
Rotation
kV 80 80 80 80 80
mA 640 400 620 620 400
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 300/35 300/35 300/35 300/35 300/35
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250
Neck: (Salivary Gland) (Protocol – Adult: # 3.3 – Pediatric: # 13.3)
Billing: 1. CT Neck (without and with)

2. Contrast
Setup: 1. Patient Supine (AP and lateral scouts from sella to mid chest)
2. Make sure the patient removes any dentures or removable teeth
3. No gantry angle
Examination: Part 1: Limited Non-contrast CT of Neck
- Scan from hyoid bone to EAC
- Add angled views if there are lots of dental fillings
- No 2D Reconstructions
- Use same scan factors as in routine neck CT
Part 2: Do a routine Neck CT W ith Contrast Protocol
- Be sure to do angled views if there are lots of dental fillings
Neck: (Vascular Mass) (Protocol – Adult: # 3.3 – Pediatric: # 13.3)
Billing: 1. CT Neck with and without

2. Contrast
Setup: 1. Monitored exam (ENT Attending or ENT Fellow)
2. Extend the scouts to include the superior vena cava for smart prep.
3. Patient supine, AP and lateral scouts from sella to mid chest, no gantry angle
4. Have the patient remove any dentures or removable teeth, please place the shoulders
as low possible
5. Start the scan at the carina and scan to the top of the orbit
7. Do angled views if lots of artifact from dental fillings or metal hardware
Exam: Part 1: Limited Non-contrast CT of Neck (scan area per radiologist)
Part 2: Dynamic Contrast Enhanced Exam -Through the Vascular Mass (as described below)
1. Select eight 2.5 mm scans through the vascular mass (ROI per radiologist)
2. Use 100 kV; 300 mA for adults, 150 mA for peds less than 6 y/o.
3. 1 image per sec X 5 (Using Cine Mode), then 1 image every 3 sec. X 3, then 1 image
every 10 seconds X 2 (5 groups using Axial Mode with a Prep Group Delay of 2 sec
and 9 sec respectively) (scan time = 34 sec).
5. Smart prep over the superior vena cava. Start scanning with the arrival of contrast
6. Adults: Inject 50 ml of 300 mg/ml at 4.0 ml per sec (Injection time = 18.7 sec)
7. Pediatrics: Inject 0.5 ml/lb (1 ml/kg) of 300 mg/ml contrast at 2 ml per sec
8. As soon as all contrast has been injected immediately start Part 3
Part 3: Routine Neck CT with Contrast (with the following modifications)
1. Perform a Routine Neck CT Protocol (Use the same scan factors as in that protocol)
2. Adults: Begin an additional injection of 50 ml of 300 mg/ml at 3.0 ml per sec and
immediately start scanning (no smart prep) from the carina to the top of the orbit.
3. Pediatrics: Begin an additional injection of 0.5 ml/lb (1 ml/kg) of 300 mg/ml contrast
at 2 ml per sec and immediately start scanning (no smart prep) from the carina to
the top of the orbit.
4. Use a 50 ml saline chaser in adults and a 10-25 ml saline chaser in pediatrics.
5. Do angled views if necessary
Recons & Reformats:

Part 1: No 2D recons or bone algorithm, only axial standard algorithm images
Part 2: No 2D recons or bone algorithm, only axial standard algorithm images
Part 3: A. Adult scans: There is a soft tissue 2.5 mm slice thickness for Recon 1, a bone plus 1.25
mm slice thickness for Recon 2, and a soft tissue 1.25 mm slice thickness for Recon 3.
Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm
slices in Recon 3 for the soft tissue reformats. Use the 1.25 mm slices in Recon 2 for the
bone reformats.
B. Pediatric scans: There is a soft tissue 1.25 mm slice thickness for Recon 1, a bone plus
1.25 mm slice thickness for Recon 2, and a bone plus 0.625 mm slice thickness for Recon
3. Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm
slices in Recon 1 for the soft tissue reformats. Use the 0.625 mm slices in Recon 3 for the
bone reformats.
C. Do 2 mm by 2 mm 2D-Reformations in the coronal and sagittal planes
Smart Prep
40 (Adult)
Superior Vena Cava 10.0 2.0 50 3.0
20 (Peds)
Neck: Vascular Mass (Part 2 Dynamic Scan)

Contrast (Part 2 only)
Adult and Peds
kV 100 100 100 100 100
mA Adults 380 300 300 300 300
mA Peds < 6 y/o 190 150 150 150 150
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 350/20 350/20 350/20 350/20 350/20
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:
- 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.
3. Vocalization:
- 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.
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 mm3 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
Scan Factors for Part 2 only: CT Neck Perfusion Study
Neck: Perfusion CT (Part 2)

Contrast (Part 2 only)
Adult & Peds
kV 80 80 80 80 80
mA Adults 250 200 200 200 200
mA Peds < 6 y/o 130 100 100 100 100
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 350/20 350/20 350/20 350/20 350/20
Neck: (Parathyroid Adenoma) (Protocol – Adult: # 3.4 – Pediatric: # 13.4)
Billing: 1. CT Neck with

2. Contrast
Setup: 1. Patient Supine, AP and lateral scouts from sella to mid chest, no gantry angle
2. Only do on a 64 slice scanner
4. Remove any dentures or removable teeth; please place the shoulders as low possible
DFOV: 1. Part 1: 22 cm (adults), 20 cm (peds 3-6 y/o), 18 cm (peds 0-3 y/o)
2. Part 2: (as in routine neck CT)
Exam: Part 1: Arterial Phase of Lower Neck
1. Algorithm: Standard only
2. Scan Area: Start scans at the carina and scan to the bottom of the upper teeth
3. Contrast: Adult: 100 ml of Iohexol 300 with a 50 ml saline chase
Peds: 1 ml/lb (2 ml/kg) of Iohexol 300 with a 10-25 ml saline chase
4. Injection Rate: Adult: 4 ml per sec
Peds: 2.0-2.5 ml/sec
5. Smart Prep: Over aortic arch (initiate scan at the entry of contrast in the aortic arch)
6. Begin Part 2: Do a routine Neck CT Protocol immediately following Part 1 with the
following modifications.
Part 2: Routine Neck CT with Contrast (with the following modifications)
1. Perform a Routine Neck CT Protocol using the same scan factors as in that protocol
2. Do not use any CT scan delay but start scanning the routine neck CT as soon as
Part 1 is finished.
3. Do angled views if necessary
Recons & Reformats:

Part 1: A. Sagittal and coronal 2D reformations using standard algorithm images only
Part 2: A. Adult scans: There is a soft tissue 2.5 mm slice thickness for Recon 1, a bone plus 1.25 mm slice
thickness for Recon 2, and a soft tissue 1.25 mm slice thickness for Recon 3. Only send Recon 1
and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 3 for the soft
tissue reformats. Use the 1.25 mm slices in Recon 2 for the bone reformats.
B. Pediatric scans: There is a soft tissue 1.25 mm slice thickness for Recon 1, a bone plus 1.25 mm
slice thickness for Recon 2, and a bone plus 0.625 mm slice thickness for Recon 3. Only send
Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 1 for
the soft tissue reformats. Use the 0.625 mm slices in Recon 3 for the bone reformats.
C. Do 2 mm by 2 mm 2D-Reformations in the coronal and sagittal planes
Smart Prep
Aortic Arch 80 10.0 3 50 3.0
Neck: Parathyroid Adenoma

Contrast
Adult
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Scan FOV Large Large Large Head Large
kV 120 120 120 120 120
Noise Index 11.1 11.1 11.1 11.1 11.1
(Manual mA) 530 320 510 480 360
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 3.0

Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 110
Noise Index 10.6 10.6 10.6 10.6 10.6
(Manual mA) 490 290 470 440 330
Recon 1:
DFOV 20 20 20 20 20
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 20 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 3.0

Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 10.4 10.4 10.4 10.4 10.4
(Manual mA) 440 260 420 400 300
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Brachial Plexus: (Routine) (Protocol – Adult: # 3.1 – Pediatric: # 13.1)

(Feet First) (Protocol – Adult: # 3.2 – Pediatric: # 13.2)
This protocol is the same as the routine neck CT with the following exceptions:
Billing: 1. CT Neck without, or with, or without and with

2. Contrast if used
Modifications: 1. Inject the contralateral arm from the brachial plexus of interest.
2. CT scan delay after arrival of contrast in aortic arch:
- Adult: 15 sec (all scanners),
- Peds: 10 sec (all scanners),
3. DFOV: Range 26-32 cm.
- Extend DFOV laterally to include bilateral humeral heads of the shoulders
4. 2D Reformations in addition to standard routine neck reformations (see below)
Cervical Spine: (Adult Routine) (Protocol: # 3.5)
Billing: 1. CT cervical spine without, or with, or without and with

2. Contrast if used

2. Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used.
3. Patient Positioning:
- Warning: Do not flex or extend the neck if there has been recent spine trauma or if
the patient is in a c-spine trauma collar.
- If no recent trauma, tilt the patient’s head so that a line connecting the lateral
canthus of the eye and the EAC is perpendicular to the CT tabletop.
- The shoulders should be pulled down as much as possible
4. Scan from the top of the sella to the bottom of T2
Contrast: 1. Injection parameters:

2. Volume: 100 ml of 240 mg/ml nonionic contrast (use 150ml of 240mg/ml if a CT of the
head will also be obtained).
3. Injection Rate: Adults: 3.5 ml/sec
5. CT scan delay after arrival of contrast in aortic arch: 10 sec (8 slice scanners),
15 sec (16 slice scanners), 20 sec (64 slice scanners)
Recons & Reformats:

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats. Do them in the
coronal and sagittal planes.
2. You must include the entire larynx and hyoid bone on the sagittal 2D reformats (see below)
3. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using both
the standard 1.25 mm images (Recon 1) AND the bone 0.625 mm images (Recon 2)
Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series
AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images (Recon 2) from the
non-contrast series.
Smart Prep
LS VCT64: 20.0
Aortic Arch 80 10.0 3.0 50 LS Xtra, LS 16 & 16 Pro: 15.0
LS 8: 10.0
Cervical Spine: Routine

Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 140 140 140 140 140
Noise Index 16.2 16.2 16.2 16.2 16.2
(Manual mA) 450 290 480 450 330
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 450/60 450/60 450/60 450/60 450/60
Recon 2:
DFOV 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Thoracic Spine: (Feet First) (Adult Routine) (Protocol: # 7.5)

Thoracic Spine: (Head First) (Adult Routine) (Protocol: # 7.6)
Billing: 1. CT thoracic spine without, or with, or without and with

2. Contrast if used

3. Non-contrast unless otherwise protocoled
4. Scan from the top of C7 to the bottom of L1
5. Post myelography patients: Please remember to roll the patient 360 degrees before
scanning to distribute the contrast evenly in the spinal canal.

2. Volume: 100 ml of 240 mg/ml nonionic contrast (use 150ml of 240mg/ml if a CT of the
For Large Patients: Increase scan time to 1.0 sec on CT1, CT3, CT4, and ER CT.
Raise kV to 140 kV on CT2, East & RP CT.
For VERY large patients, increase scan time to 1.0 sec and increase kV to 140 kV
on CT1, CT3, CT4, and ER CT.
Recons & Reformats:

the coronal and sagittal planes.
Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast
series AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images (Recon 2)
from the non-contrast series.
Smart Prep
LS VCT64: 20.0
LS 8: 10.0
Thoracic Spine: Routine

Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 120 120 120 120 120
Noise Index 14.4 14.4 14.4 14.4 14.4
(Manual mA) 330 180 320 300 180
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 450/60 450/60 450/60 450/60 450/60
Recon 2:
DFOV 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Lumbar Spine: (Adult Routine) (Protocol: # 7.1)
Billing: 1. CT lumbar spine without, or with, or without and with

2. Contrast if used

4. Scan from the top of T12 to the top of S2

2. Volume: 100 ml of 240 mg/ml nonionic contrast (use 150 ml of 240 mg/ml if a CT of the
For Large Patients: Increase scan time to 1.0 sec on CT1, CT3, CT4, and ER CT.
Raise kV to 140 kV on CT2, East & RP CT.
For VERY large patients, increase scan time to 1.0 sec and increase kV to 140 kV
on CT1, CT3, CT4, and ER CT.
Recons & Reformats:

series AND also do 2mm x 2mm reformats using the bone 0.625 mm images (Recon 2)
Smart Prep
Prep Over mA Diagnostic Delay (sec)
(sec) ISD (sec) Threshold
LS VCT64: 20.0
LS 8: 10.0
Lumbar Spine: Routine

Adult
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 120 120 120 120 120
Noise Index 14.4 14.4 14.4 14.4 14.4
(Manual mA) 330 180 320 300 180
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 450/60 450/60 450/60 450/60 450/60
Recon 2:
DFOV 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Cervical Spine: (Pediatric Routine) (Protocol: # 13.5)
Billing: 1. CT cervical spine without, or with, or without and with

2. Contrast if used
3. Patient Positioning:
- Warning: Do not flex or extend the neck if there has been recent spine trauma or if
the patient is in a c-spine trauma collar.
- If no recent trauma, tilt the patient’s head so that a line connecting the lateral
canthus of the eye and the EAC is perpendicular to the CT tabletop.
- The shoulders should be pulled down as much as possible
4. Scan from the top of the sella to the bottom of T2
scanning in order to distribute the contrast evenly in the spinal canal.
2. Volume: 1 ml/lb (2 ml/kg) of 240 non-ionic contrast.
3. Injection Rate: 2 ml/sec
5. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanners),
Recons & Reformats:
2. You must include the entire larynx and hyoid bone on the sagittal 2D reformats (see
below)
Smart Prep
LS VCT64: 10.0
LS 8: 5.0

10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 120 120 120 120 120
Noise Index 14.9 14.9 14.9 14.9 14.9
(Manual mA) 420 240 400 380 270
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 450/60 450/60 450/60 450/60 450/60
Recon 2:
DFOV 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
LS VCT64: 10.0
LS 8: 5.0

Pediatric Infant (0 – 3yr)
10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 14.5 14.5 14.5 14.5 14.5
(Manual mA) 360 220 350 330 220
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 450/60 450/60 450/60 450/60 450/60
Recon 2:
DFOV 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Thoracic Spine: (Pediatric Routine) (Protocol: # 17.5)
Billing: 1. CT thoracic spine without, or with, or without and with

2. Contrast if used

4. Scan from the top of C7 to the bottom of L1

5. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanners),
Recons & Reformats:

Smart Prep
LS VCT64: 10.0
LS 8: 5.0

10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Scan FOV Large Large Large Medium Body Large
kV 100 100 100 100 100
Noise Index 12.8 12.8 12.8 12.8 12.8
(Manual mA) 310 190 300 280 190
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 450/60 450/60 450/60 450/60 450/60
Recon 2:
DFOV 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
LS VCT64: 10.0
LS 8: 5.0

10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Scan FOV Small Small Small Small Body Small
kV 80 80 80 80 80
Noise Index 11.3 11.3 11.3 11.3 11.3
(Manual mA) 280 170 270 260 170
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 450/60 450/60 450/60 450/60 450/60
Recon 2:
DFOV 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Lumbar Spine: (Pediatric Routine) (Protocol: # 17.1)
Billing: 1. CT lumbar spine without, or with, or without and with

2. Contrast if used

4. Scan from the top of T12 to the top of S2

5. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanner),
Recons & Reformats:

Smart Prep
LS VCT64: 10.0
LS 8: 5.0

10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Scan FOV Large Large Large Medium Body Large
kV 100 100 100 100 100
Noise Index 12.8 12.8 12.8 12.8 12.8
(Manual mA) 310 190 300 280 190
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 450/60 450/60 450/60 450/60 450/60
Recon 2:
DFOV 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
LS VCT64: 10.0
LS 8: 5.0

10 10 10 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Scan FOV Small Small Small Small Body Small
kV 80 80 80 80 80
Noise Index 11.3 11.3 11.3 11.3 11.3
(Manual mA) 280 170 270 260 170
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 450/60 450/60 450/60 450/60 450/60
Recon 2:
DFOV 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.375 0.375 0.375 0.312
Recon 3:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.625 0.75
Stealth (Stereotactic) Spine: (Protocol: # 7.2)
Billing: 1. CT Stereotactic
2. Contrast if used
Setup: 1. Patient Supine, AP and lateral scouts

2. No gantry angle
4. Scan one vertebrae above and below the vertebrae of interest. The region of interest
should be noted on the CT request or CT protocol.
5. Call ordering M.D. to verify levels if necessary.
DFOV: 14 cm (for average patient)
Scan Factors:
1. Mode = Axial
2. Rotation = 1 sec
3. Detector Config = 1.25 @ 8i
4. Interval = 10.0
5. KVP = 120
6. MA = 250
7. Algorithm = Standard
8 Scan FOV = Large
9. DFOV = 14 (for average patient)
Notes: 1. If there is ANY patient motion, start the scan over.

2. Do not change the DFOV, centering, or move the patient during the CT exam.
3 Only the axial images are to be archived on the MOD that goes to the surgeon.
4. When IV contrast is needed, wait until it is all injected before starting the scan.
5. No bone windows are needed.
6. No overlapping slices.
7. Technical support is available 24 hours and day, 7 days a week at 800-595-9709.
Vascular Imaging: Stroke Deluxe: (Acute Stroke Workup)

(Protocol – Adult: # 1.6 & 3.7 – Pediatric: # 11.16 & 11.17)
Billing: 1. CT Head with and without

2. CTA Head and Neck with contrast
3. CT Brain Perfusion
4. Contrast
Setup: 1. Patient Supine, AP and lateral scouts, No Gantry Tilt

2. Extend the scouts to include the aortic arch for smart prep.
3. 16 or 64 slice scanners only
Exam: Part 1: Routine Head CT without contrast (helical)

Part 2: CTA Head and Neck
1. Scan Area from the top of the head to the bottom of the carina (see below)
2. Scan direction scan from top to bottom
3. Contrast Adult: On LS VCT 64 and LS 16 Pro:
100 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase
Adult: On LS 16, LS 8 and LS 4:
4. Injection Rate Adult: 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast transit time)
5. Smart Prep over aortic arch (initiate the scan at the entry of contrast in the aortic arch)
Part 3: CT Perfusion (see perfusion page for details)
1. Wait at least 5 min from start of CTA contrast injection before beginning Perfusion Injection.
2. Contrast 40 ml of 370 nonionic contrast (14.8 g Iodine) with 30 ml saline chase
3. Injection Rate Adults: 5 ml per sec with a 5 sec prep delay
Pediatric: 3-5 ml per sec (Depends on size of needle and age of patient)
4. Prep Delay 5 seconds
Part 4: Routine Head CT with contrast (helical)
1. Perform immediately after Perfusion Imaging (Part 3). No need to wait 5 min.
Networking:
1. ALI store, CTAW2 and CTAW 3
Post Processing:
1. 2-D Reformation Instructions
(Appendices 1 and 2)
2. Perfusion Analysis (3D Lab)
(Appendices 3 and 4)
3. 3D Intravascular Image Analysis
on ADW workstation
(Do on Stent Cases)
Smart Prep
Aortic Arch 80 10.0 3 50 3.0
CTA: Stroke Deluxe

Contrast
Adult
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 120 120 120 120 120
Noise Index 11.1 11.1 11.1 11.1 11.1
(Manual mA) 530 320 510 480 360
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 3.0
CTA: Stroke Deluxe:

Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 110
Noise Index 10.6 10.6 10.6 10.6 10.6
(Manual mA) 490 290 470 440 330
Recon 1:
DFOV 20 20 20 20 20
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 20 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 3.0
CTA: Stroke Deluxe:

Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 10.4 10.4 10.4 10.4 10.4
(Manual mA) 440 260 420 400 300
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Vascular Imaging: Total Cerebrovascular: (Stenosis, Trauma, Unknown Bleed)

(Protocol – Adult: # 1.6a or 13.7a – Pediatric: # 11.16 or 11.17)
Note: This protocol is identical to the stroke deluxe protocol.

Vascular Imaging: CTA Head Only: (Stenosis, Unknown Bleed):

2. CTA Head with contrast
3. CT Brain Perfusion if done
4. Contrast used if done
3. 16 or 64 slice scanners
the eye and the EAC is perpendicular to the CT tabletop (see below).
Part 2: CTA Head Only

1. Scan Area from the top of the head to the bottom of C2 (see below)
3. Contrast Adult: 80 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase
5. Smart Prep over aortic arch (initiate the scan at the entry of contrast in the aortic arch)
Part 3: CT Perfusion (see perfusion page for details)
1. Wait at least 5 min from start of CTA contrast inject before beginning Perfusion Injection.
1. If Perfusion is done, perform immediately after the Perfusion Imaging - No need to wait 5 min.
2. If Perfusion is not done, perform scan at least 5 min after start of CTA contrast injection
Networking: 1. ALI store, CTAW2 and CTAW3
Processing: 1. Thick Slab Reformat Instructions (See Appendix 1)
2. Perfusion Analysis (3D Lab) (See Appendices 3 and 4)
3. 3D Intravascular Image Analysis on ADW workstation (Do on Stent Cases)
Smart Prep
Aortic Arch 80 10.0 3 50 3.0
CTA: Head Only

Contrast
Adult
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 6.6 6.6 6.6 6.6 6.6
(Manual mA) 620 380 600 570 420
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 450/60 450/60 450/60 450/60 450/60
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 3.0
CTA: Head Only:

Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 6.0 6.0 6.0 6.0 6.0
(Manual mA) 540 330 520 490 370
Recon 1:
DFOV 20 20 20 20 20
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 20 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 3.0
CTA: Head Only:

Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 5.2 5.2 5.2 5.2 5.2
(Manual mA) 440 290 440 410 330
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Vascular Imaging: Aneurysm (Hi-Res COW): (Nontraumatic SAH, Known Aneurysm)

2. CTA Head with contrast
3. Contrast
DFOV: 18 cm
Part 2: CTA Head Only
1. Scan Area From the top of the lateral ventricles to the bottom of the C2 vertebrae (use
Part 1 to select the top slice, see below)
5. Smart Prep Over aortic arch (initiate the scan at the entry of contrast in the aortic arch)
Option: CT Perfusion (see perfusion page for details)
1. Wait at least 5 min from start of CTA contrast inject before beginning Perfusion Injection.
1. If Perfusion is done, perform immediately after the Perfusion Imaging - No need to wait 5 min.
2. If Perfusion is not done, perform scan at least 5 min after start of CTA contrast injection

Smart Prep
Aortic Arch 80 10.0 3 50 3.0
CTA: Aneurysm (Hi-Res COW)

Contrast
Adult
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 6.6 6.6 6.6 6.6 6.6
(Manual mA) 620 380 600 570 420
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 450/60 450/60 450/60 450/60 450/60
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 3.0
CTA: Aneurysm (Hi-Res COW):

Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 6.0 6.0 6.0 6.0 6.0
(Manual mA) 540 330 520 490 370
Recon 1:
DFOV 20 20 20 20 20
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 20 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 3.0
CTA: Aneurysm (Hi-Res COW):

Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 5.2 5.2 5.2 5.2 5.2
(Manual mA) 440 290 440 410 330
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Vascular Imaging: CTA Neck Only: (Cerebrovascular Disease)

Billing: 1. CTA Neck/Arch (with contrast)

2. Contrast
Setup: 1. Patient Supine, AP and lateral scouts, no gantry tilt

canthus of the eye and the EAC is perpendicular to the CT tabletop (see head CT
protocol).
Examination: CTA Neck and Arch

1. Scan Area Start scans at the carina and scan to the EAC (see below)
2. Scan direction Scan from bottom to top
3. Contrast Adult: On LS VCT 64 and LS 16 Pro:
Adult: On LS 16, LS 8 and LS 4:
4. Injection Rate Adult: 4 ml per sec
5. Smart Prep Over aortic arch (initiate the scan at the entry of contrast in the aortic arch)
Smart Prep
Aortic Arch 80 10.0 3 50 3.0
CTA: Neck Only

Contrast
Adult
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 120 120 120 120 120
Noise Index 11.1 11.1 11.1 11.1 11.1
(Manual mA) 530 320 510 480 360
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 3.0
CTA: Neck Only

Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 110
Noise Index 10.6 10.6 10.6 10.6 10.6
(Manual mA) 490 290 470 440 330
Recon 1:
DFOV 20 20 20 20 20
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 20 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 3.0
CTA: Neck Only

Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 10.4 10.4 10.4 10.4 10.4
(Manual mA) 440 260 420 400 300
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Vascular Imaging: CT Venography:

(Protocol – Adult: #1.9 & 3.9 – Pediatric: # 11.24 & 11.25)

2. CTA of Head +/- CTA of Neck with contrast
3. Contrast

Part 2: CTV Head

1. Scan Area From the top of the head to the bottom of C2 (see below)
2. Scan direction Scan from top to bottom
4. Injection Rate Adult: 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast
transit time)
5. Smart Prep Over aortic arch (initiate the scan 5 seconds after entry of contrast in
the aortic arch)
Part 2b: Option: CTV Head and Neck

1. Do as in Part 2 except:
2. Scan Area: From the top of the head to the carina

1. Wait at least 5 min from start of CTV contrast injection before beginning scan.
Smart Prep
Aortic Arch 80 10.0 3 50 5.0
CT Venography
Contrast
Adult
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Scan FOV Medium Medium Medium Head Medium
kV 120 120 120 120 120
Noise Index 11.1 11.1 11.1 11.1 11.1
(Manual mA) 530 280 510 480 320
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 22 22 22 22 22
WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 5.0
CT Venography:
Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 100 100 100 100 100
Noise Index 10.6 10.6 10.6 10.6 10.6
(Manual mA) 490 260 470 440 290
Recon 1:
DFOV 20 20 20 20 20
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 20 20 20 20 20
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Smart Prep
Aortic Arch 40 10.0 3 50 5.0
CT Venography:
Contrast
20 20 20 20 10
Pitch 0.562 0.562 0.562 0.531 0.625
Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25
Interval (mm) 0.75 0.75 0.75 0.625 0.75
kV 80 80 80 80 80
Noise Index 10.4 10.4 10.4 10.4 10.4
(Manual mA) 440 230 420 400 260
Recon 1:
DFOV 18 18 18 18 18
WW/ WL 400/40 400/40 400/40 400/40 400/40
Recon 2:
DFOV 18 18 18 18 18
WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300
Interval (mm) 0.75 0.75 0.75 0.625 0.75
Appendix # 1
CTA Head: 2D Thin and Thick Slab Reformations
A. Do Thin 2D-Reformations through the vertebral and carotid arteries
1. 1 mm X 1 mm right oblique sagittal (see example below) (FOV = 12)
2. 1 mm X 1 mm left oblique sagittal (mirror image of example below) (FOV = 12)
a. Make sure the reference line is parallel to the carotid canal (see image below)
b. Use a window with and level of 800/200
c. Axial images to use for obtaining the oblique sagittal 2-D Reformations
- CTA Head Protocol: Images from C2 to the top of the lateral ventricles
- CTA Head and Neck: Images from C2 to the top of the lateral ventricles
d. Send to ALI Store
B. 2D Thick-Slab MIP Reformats of Head:

1. Choose the 1.25 mm slices
2. Select Ref. Detail.
3. Use a window width 600 and window level 200
4. Choose batch. (You don’t need to change slice thickness & rendering mode on image 1st)
5. Do axial, sagittal, and coronal thick-slab MIPs through the entire head. (See examples below)
6. Change the slice thickness to 10 mm with an interval of 2.5 mm and change the rendering mode from
Average to MIP.
7. Send to ALI Store.
8. Put the CT Angio request in the box on the wall in the E3/3 control room for the 3D to be done.
9. All patients should have a duplicate request made, write duplicate on it, put the duplicate request in the 3D
box, all remaining requests go to the neuro reading room.
Appendix # 2
CTA Neck: 3D Vascular Analysis and 2D-Reformations
A. 3D Analysis through the vertebral and carotid arteries
1. For each carotid bifurcation, calculate the percent stenosis (NACET) using Vitrea
2. Do 1 mm by 1 mm curved reformations through any vessel that has been previously stented
3. Send all images to ALI Store.
B. Do 2D-Reformations through the vertebral and carotid arteries
1. Use an axial image near the level of the hyoid bone at the carotid bifurcation to prescribe the correct
oblique angles. Use an image that shows the external and internal carotid arteries.
2. Choose only the axial images from the aortic arch to the EAC.
3. Use a window width 800 and window level 200
4. Bilateral oblique sagittal 2D reformations: Do 2 mm X 2 mm reformations thru each carotid bifurcation.
Angle so that the reformations go through both the external and internal carotid arteries. (See below)
5. Coronal 2D reformations: Do 2 mm X 2 mm reformations thru both sides at the same time. Include both
the carotid and vertebral arteries (See example below)
6. Send to 3D Lab for Intravascular Analysis of the carotid bifurcations (i.e. severity of carotid stenosis).
7. Send all images to ALI Store.
8. All patients should have a duplicate request made, write duplicate on it, put the duplicate request in the 3D
box, all remaining requests go to the neuro reading room.
Oblique Sagittal 2D-Reformats

Through Carotid Bifurcations
Coronal 2D-Reformats
Through Carotid Bifurcations
Appendix # 3
CT Perfusion Protocol: (Specific Instructions):
Billing: 1. Perfusion and contrast used

3. Usually done in conjunction with a CT/CTA of the Head or CT/CTA of Head/Neck
Exam: CT Perfusion
1. Scan Type Cine
2. Cine Duration 45 seconds
3. Perfusion Area (next page)
4. Contrast 40 ml of 370 nonionic contrast with 30 ml saline chase
5. Injection Rate Adult: 5 ml per sec
Pediatric: 3-5 ml per sec (Depends on size of needle and age of
patient)
7. Perfusion Slabs Use maximum number (4-8-16) of contiguous 5 mm slabs allowed
by each specific CT scanner (use toggle/shuttle mode if possible)
Perfusion Locations: (See next Page)
Perfusion Post Processing: (see Appendix 5 for further details):

1. Prospectively reconstruct the images to .5 seconds. This is found under thick/speed - (Go
under show recon 2).
2. When you are in recon 2, enter the RAS coordinates manually.
3. Network raw perfusion images to CTAW3 & ALI Source – DO Not send the perfusion part to
ALI store
CT Perfusion:
Contrast
Adult and Pediatric
Scan Type Cine Cine Cine Cine Cine
Cine Time Between Images 0.5 sec 0.5 sec 0.5 sec 0.5 sec 0.5 sec
kV 80 80 80 80 80
mA Adults 250 200 200 200 200
mA Peds < 6 y/o 190 150 150 150 150
Cine Duration (sec) 45 45 45 45 45
Recon 1:
DFOV 22 22 22 22 22
WW/ WL 350/20 350/20 350/20 350/20 350/20
Appendix # 4: CT Perfusion Coverage
A. 8-16 Channel CT Perfusion:

(4 slice coverage)
B. 64 Channel CT Perfusion:
Non-shuttle Mode
(8 slice coverage)
C. 64 Channel CT Perfusion: Obtain 16 contiguous 5 mm slices from EAC Upward

Shuttle/Toggle Mode:
(16 slice coverage)
Appendix # 5: CT Perfusion Analysis Instructions
Suggestions for RO I Placement

Suggestions for RO I Placement
Continued on next page

GE Advantage: CT Perfusion Post Processing Protocol
a. Select Perfusion series from patient list

b. From Applications menu at right of screen choose CT PerfusionN (exam will load)
c. From list of protocols choose Brain Tumor
d. Using slide bar at bottom of upper left port, slide back and forth to look for motion. If there
is motion click apply registration, then click next. If not, click next.
e. Now you will see a box called Processing Thresholds. Your object here is to get all little
boxes/pixels out of the brain tissue and include as much brain parenchyma as you can.
Your slide bar that you used to check for motion must be all the way to the left and rank
should be 1/89. Slide air bar to left to remove boxes/pixels from ventricles and there are
any diagonal lines with pieces missing, this air bar may fill them in. This is a very slight
movement. Your average range should be (-27 to around -63). It can go higher and that is
ok but usually doesn’t
f. Slide bone bar to right to bring circle out to edge of bone only. This is easiest when using a
bone window. Middle mouse will change window/level. Click next.
g. Using slide bar in upper left port again, move it left to right to find a slice where contrast is
fairly bright. Look on upper slices for anterior cerebrals, just above frontal horns.
This is the best place to look for an artery. You can move up levels by right-clicking
on your image location in your upper left port. Click on ROI to the left of your screen
and place over an artery. Click next. This should result in a small purple circle being
placed in an artery with a label and arrow.
h. Now do the same for a vein. A good place to look is down in the sinus. Click next. If you
have gone up several levels to find your vein/artery, make sure you go back to the
beginning to place your ROIs! The vein and artery do not have to be on the same slice!
i. Roam your image over to the right. Do this by grabbing the “P” on the bottom of your
upper left port (you will see a hand) and moving your head.
j. Now place your cursor in the upper right port and hit the space bar. This will bring up a
graph with 2 lines (1) and (2). 1 is the artery you marked and 2 is the vein. On the line that
says “Last pre-enhancement image” grab the number and a white line will appear in your
graph. You want to move the line to the last spot before the contrast spikes. You do this on
line 1 only. (If you are having trouble seeing the 2 lines separately, click on the word artery
in your upper left port. This will activate it and turn it green and you will be able to
distinguish the two lines. When you are done click in the upper left port to de-activate the
artery so it returns to purple.) Click next.
k. Click compute. This will take a minute. Close Final Settings box.
l. In the lower left port there will be a drop down menu under DFOV called Blood Flow.
Change this view to Mean Transit Time.
m. Click on Film/Save box and choose ROIs/Templates. Click on Neuro template for upper
levels and Neuro-lower for lower levels (the only difference between these two is that
Neuro-lower only has 2 ROIs to place instead of four. Hit Load. This will bring up your
ROIs and Axis line. You may need to adjust their placement depending on your centering.
You can now close this box.
n. Look for any obvious perfusion abnormality. This is where you will place your ROI. If there
isn’t any obvious abnormality then you will place your ROIs in the standard places.
o. You must straighten the Axis line by grabbing the boxes at either end to split the
brain into two equal hemispheres.
p. After you have done this, hold the control key down and click on all ROI’s and the axis line.
This will turn them all green. Go back to the symmetry button and there is a little black tab,
open that and click on that button. This will place the ROI’s on the left side. Now you are
ready to film.
q. In the upper left port, right mouse click and save view .
r. In the upper right port go outside yellow box and right mouse click and save view . After
doing that there are some numbers in red at the top and bottom left of the grid. Grab the
numbers at the top and middle mouse scroll to the left. This should move your 1 and 2
graph up and out of the yellow box and bring the ROI’s you just created up in view. If it
doesn’t, you can also grab the numbers at the bottom and bring them up. Once they are in
view right mouse click and click on multiple graphs. This will show them in a nice graph.
s. Go out of the yellow box again and save view .
t. Place your cursor in the lower right port and on your keyboard hit the key with the (?/).
This will bring up all 4 views at once. Now you can film them in order without having to
change each one. Film Mean Transit Time first, then Blood Flow, Blood Volume, and
Permeability Surface.
u. Go Back up to your upper left port and hold down the control key and click on your ROI’s
to turn them green. Hit CTRL-C to copy. Go to the image location and right mouse click to
go to the next level. This will take a minute to process. Once it is done, Hit CTRL-V to
paste or you can also use the right click menu.
v. Now all ROI’s will be in the same spot as before. You may need to move them just a hair if
they get too close to bone or a big blood vessel but otherwise try to leave them in the
same spot.
w. Now repeat all filming. Upper left port first, upper right port next, Mean Transit Time, Blood
Flow, Blood Volume, Permeability Surface. This time when you finish you just click on the
next level. You don’t need to copy again because you have already done it once. If you
move them a lot you will need to make them green again and recopy. When you get to the
third level, CTRL-V or right click to paste your ROI’s, adjust them if necessary, then film.
x. After you have done all four/eight levels, click on film/save. Choose Functional Data and
hit save. This will bring up a graph to the right called functional data. Click next until the
button goes gray, and go back to the film/save box and click save again.
y. Now you can exit and go back to the patient list. Send to ALI-STORE.
1. CTRL-C copy
2. CTRL-V or right click menu to paste
3. CTRL-X cut
4. CTRL and click to make ROI’s green
Vitrea: CT Perfusion Post Processing Protocol
a. Go to PACS and choose perfusion series.

b. Right click 3D and choose “View selected series in Vitrea 3D”. This will launch Vitrea and
may take a few minutes.
c. When perfusion comes up, it will be auto-selecting your artery and vein. The amount of
time it takes will show on the task bar at the bottom of the screen. You need to check the
placement of both vessels. Before you do this check for rotational motion. If there is
motion click on motion correction. This should help unless the patient picked up their head
completely. If no motion proceed with checking artery and vein placement. If you are
happy with the vessels selected, click compute. If not scroll to your alternate location and
left click to draw oval over the new artery. Click artery button. Do the same for the vein.
These do not have to be on the same slice. After you have manually selected vessels click
compute.
d. You will now have your 4 main images – grey scale, blood volume, blood flow and mean
transit time. Scroll to first image and check axis line for centering. If it needs adjusting, do
so.
e. Click on ROI Templates, choose the one that has square ROI’s all around periphery and 2
oval ROI’s in the center. Tight fit which is the box directly below this, should be checked.
There is no need to adjust ROI’s. If you want to make them bigger, you can change the
thickness. Default thickness is 15 mm and default count of ROI’s is 12.
f. You are done except for screen saving images.
g. Click on the camera (snap) or hit S on the keyboard. This activates the camera. Hold down
the control key and left click in the grey-scale port (upper left hand box). Do this for all
levels. On the bottom left task bar click back to HRS. Export all.
Helpful hints:
a. Wheel-roll the wheel in the middle of the mouse to go up and down levels.
b. Window/Level-Click on the window/level button in the upper left hand side of the machine
and left click with your mouse to change w/l. you MUST change back to ellipse when
done.
c. To delete something click on it to make it purple and hit delete on the keyboard.
d. To screen save images-click on camera (snap) or hit S on the keyboard, hold down ctrl
and left-click. This will save all four images as long as you are in upper left hand port.
Appendix: 6
Neck CT Contrast Timing Table For Routine Neck CT
CT Scan Contrast
Time
Injection Volume Delay after volume injected
Total available to
Scanner Injection Volume contrast from detection
Saline Injection scan from the
(Age) Rate (300 arrival in by Smart Prep
Volume initiation of
mg/dl) Chaser arch on to Start of CT
the CT scans
Smart Prep Scan
64 Slice
3.0 100 50 150 20 33.3 - 20 >13.3 sec
(Adult)
16 Slice
3.0 100 50 150 15 33.3 - 15 >18.3 sec
(Adult)
8 Slice
3.0 100 50 150 10 33.3 - 10 >23.3 sec
(Adult)
64 Slice Volume
2.0 1 ml/lb 10-25 ? 5 ?
(Peds) Dependant
16 Slice Volume
2.0 1 ml/lb 10-25 ? 7 ?
(Peds) Dependant
8 Slice Volume
2.0 1 ml/lb 10-25 ? 10 ?
(Peds) Dependant
Appendix: 7
64 Slice Scanner Priorities
1. CTA (High-res COW)

2. CTA (Stroke Deluxe)
3. Temporal Bone CT
4. Any Pediatric CT
5. C-Spine CT
6. T-Spine CT
7. Orbit, Maxiface, Sinus CT
8. Neck-Nasopharynx CT
9. L-Spine CT
10. Brain CT
Appendix: 8
CT Scanner Type
Scanner - # of Thinnest Minimum Weight*

Scanner Name
Location Slices Slice Scan Time Limits
LightSpeed Xtra
CTI – 1 16 0.625 0.4 sec 500
(LS Xtra)
LightSpeed 16
CTI – 2 16 0.625 0.4 sec 400 - 450
(LS 16)
LightSpeed 16 Pro
CTI – 3 16 0.625 0.4 sec 400 - 450
(LS 16 Pro)
LightSpeed VCT 64
CTI - 4 64 0.625 0.4 sec 500
(LS VCT 64)
LightSpeed VCT 64
ER 64 0.625 0.4 sec 500
(LS VCT 64)
LightSpeed 8
CT-RP 8 1.25 0.5 sec 400 - 450
(LS 8)
LightSpeed 8
East 8 1.25 0.5 sec 400 - 450
(LS 8)
* When one number is given, that is the maximum allowed weight limit AND the table
positioning accuracy at that weight limit is 0.25 mm. When two numbers are given the first
indicates the weight limit that will provide 0.25 mm positional accuracy; the second number is
the absolute maximum allowed weight limit and will provide a positional accuracy of 1.0 mm.
Appendix: 9
CT Scanner Limits
mA Limits
Scanner Name Scan FOV 140 kV 120 kV 100 kV 80 kV
All except Ped Head 715 800 770 675

LS VCT 64 & LS 16 Pro
Ped Head 170 200 240 300
All except Ped Head 380 440 420 400

LS 16, & LS 8,
Ped Head 170 200 240 300
Scan FOV
Maximum Display Default Display
Scanner Name Scan FOV
FOV (cm) FOV (cm)
Large Body 50 50
Medium Body 50 36
Small Body 32 25
LS VCT Head 32 25
Small Head 32 25
Ped Body 32 20
Ped Head 32 20
Large 50 50
LS 16 Pro, Small 25 25
LS 16, & LS 8,
Head 25 25
Ped Head 25 25
Appendix: 10
Direction and Naming of 2D-Reformations
1. Always do Bone 2D-Reformations before Soft Tissue 2D Reformations
2. Always do 2D-Reformations in this order:

a. Axial
b. Coronal
c. Sagittal
d. Oblique Sagittal
3. Always do 2D-Reformations in these directions

a. Axial = Bottom to Top
b. Coronal = Front to Back
c. Sagittal = Right to Left
d. Oblique Sagittal = Right to Left
4. Naming of 2D-Reconstructions
a. Axial Bone = AX BONE
b. Coronal Bone = CO BONE
c. Sagittal Bone = SA BONE
d. Right Oblique Bone = RT BONE
e. Left Oblique Bone = LT BONE
f. Axial Soft Tissue = AX ST
g. Coronal Soft Tissue = CO ST
h. Sagittal Soft Tissue = SA ST
i. Right Oblique Soft Tissue = RT ST
j. Left Oblique Soft Tissue = LT ST
k. TB - Right Stenver’s = RT STENV
l. TB - Right Pöschel = RT POSCH
m. TB - Left Stenver’s = LT STENV
n. TB - Left Pöschel = LT POSCH
o. CTA - Right Carotid Bifurcation = RT Car
p. CTA - Left Carotid Bifurcation = LT Car
q. CTA - Right ICA Oblique = RT ICA
r. CTA - Left ICA Oblique = LT ICA
Appendix: 11
Combined Neuro and Body Contrast Studies
1. Split the total contrast dose equally with Body/Chest/Abdomen so that neuro has a
total of about 50 cc of 300 mg / ml of nonionic contrast unless otherwise indicated.
2. When the neuro CT study follows a body/chest/abdomen study, initiate the neuro CT
scans immediately after detection of contrast on smart prep. Do not use a CT delay in
these cases.
3. Modify the injection parameters of the following studies for the combined studies as
follows: (Omnipaque 300 unless otherwise specified) (Note: CTA studies will require a
total dose of contrast that exceeds 150 ml)
Volume (cc) Rate (cc/sec)
A. CTA Head Only: 50 4
B. CTA Head with Perfusion: (only 64 slice scanner)

- CTA (Omnipaque 300) 40 3.3
- Perfusion (Omnipaque 370) 40 5
C. CTA Head & Neck: (only 64 slice scanner) 80 2.8
D. CTA Neck Only: 50 4
E. CT Neck: 50 3
F. CT Orbit/Maxiface/Sinus/TB: 50 3
G. CT Spine (C-T-L): 50 3
H. CT Sella: 50 4
4. Do not do the following studies as combined studies with Body/Chest/Abdomen

unless the studies are urgent and a total of 150 cc of 300 mg/dl nonionic contrast can
be exceeded. Ideally, the most urgent study should be performed on one day and the
other study done on a separate day. A MRI/MRA study is an alternative when the 150
ml total dose of contrast cannot be exceeded in a particular patient.
A. CTA Head & Neck with Perfusion:

- CTA (Omnipaque 300) 80 2.8
- Perfusion (Omnipaque 370) 40 5

Neuroradiology CT Protocols

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Neuroradiology CT Protocols

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1 Revised 7/22/09 (Gentry/Ranallo)

CT Protocols: (Brain, ENT, Spine, Vascular)

Monitored By: Dr._________________________ _____ Adult Brain

Contrast: Facial Trauma:

_____ Orbit Only (use only for blowout Fxs)

Spine Levels - Coverage _____ Follow-up Adult ENT Sinus

Vascular Imaging: (CT/CTA/Perfusion) Orbit: (non-traumatic)

_____ CTA Head Only: (Cerebrovascular Disease, Unknown Bleed)

_____ CTA Neck Only: (Cerebrovascular Disease)

Table of Contents (continued):

Scanner - # of Maximum mA Naming Convention

CTI – 1 16 800 Lightspeed Xtra LS Xtra

CTI – 2 4 440 LightSpeed 16 LS 16

CTI – 3 16 800 LightSpeed 16 Pro LS 16 Pro

CTI - 4 64 800 LightSpeed VCT 64 LS VCT 64

ER 64 800 LightSpeed VCT 64 LS VCT 64

CT-RP 8 440 LightSpeed 8 LS 8

East 8 440 LightSpeed 8 LS 8

Adult Head: Routine (Helical Mode) (Protocol # 1.1)

Billing: 1. CT Head without, or with, or without and with

Setup: 1. Supine, AP and lateral scouts, no gantry angle

DFOV: Preferred 20 cm (Range 18-22)

Billing: 1. CT Head without, or with, or without and with

DFOV: Preferred 20 cm (Range 18-22)

Other Info: 1. 2D-Reformations

Head: Helical Scan with Angled Axial

Head: Helical Scan with Angled Axial

Adult Head: (Axial Mode) (Protocol # 1.3)

Billing: 1. CT Head without, or with, or without and with

Setup: 1. Supine, AP and lateral scouts

DFOV: Preferred 20 cm (Range 18-22)

Pediatric Head: Routine (Helical Mode) (< 6 years of age)

Billing: 1. CT Head without, or with, or without and with

Setup: 1. Supine, AP and lateral scouts, no gantry angle

Preferred: Preferred 16 cm (Range 14-18 cm)

Contrast: 1. 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec

DFOV: Preferred 16 cm (Range 14-18 cm)

Contrast: 1. 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec

Other Info: 1. 2D-Reformations

Head: Helical Scan with Angled Axial

Head: Helical Scan with Angled Axial

Head: Helical Scan with Angled Axial

Billing: 1. CT Head without, or with, or without and with

DFOV: Preferred 16 cm (Range 14-18 cm)

Billing: 1. CT Head without

Setup: 1. Patient Supine, AP and lateral scouts, no gantry angle

DFOV: Preferred 16 cm (Range 14-18 cm)

Head Trauma: Helical

Head Trauma: Helical

Orbit: (Routine) (Protocol – Adult: # 2.1 – Pediatric: # 12.1 & 12.2)

Billing: 1. CT Orbit without, or with, or with and without

Setup: 1. Patient Supine, AP and lateral scouts, no gantry angle.

DFOV: Preferred 14 cm (Range 14-16 cm)

Recons & Reformats:

Billing: 1. CT Orbit with or with and without

Setup Info: 1. Monitored Exam: ENT attending or fellow

Reformats: 1. Do the routine 2D orbital reformations for Part 1.

Orbit: (Vascular Mass or Carotid-Cavernous Fistula)

Scan Factors for Part 2 only: (Adult and Pediatric)

Orbit: (Vascular Mass / Carotid-Cavernous Fistula)

Billing: 1. CT Orbit without

Part 1: Routine Orbit CT without contrast

Monitored By: Dr._____________________ _ Adult Brain