Neuroradiology CT Protocols

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

Name / MRN: ___________________ / ________________ DOB: _______________ / Date of Scan: ______________ Protocoled By: Dr._________________________ Monitored By: Dr._________________________ CT Tech Name & #: ________________ / ____________ CT Scanner: ______________________________
Brain:
_____ Pediatric Brain _____ Pediatric Trauma (< 6 y/o) _____ Adult Brain _____ Pituitary & Cavernous Sinus _____ Stealth (Whole Brain Treatment Planning) _____ add 3D CT
Contrast:
_____ Without _____ With _____ Without and Check _____ With and Without
Facial Trauma:
_____ Face and Mandible (No 3D) _____ Face and Mandible (With 3D) _____ Orbit Only (use only for blowout Fxs)
Spine:
_____ Adult _____ Pediatric (< 6 Y/O) _____ Post-Myelogram _____ Haughton Rotational _____ Stealth: _____ 3D
CT (craniosynostosis, congenital facial anomaly)
Sinuses:
_____ Pediatric Diagnostic ( < 6 y/o) _____ Adult Diagnostic _____ Follow-up Adult ENT Sinus
Stealth Levels ____________ ___ Thoracic ___ Lumbar ___ Sacral
Spine Levels - Coverage

___ Cervical
Stealth (Landmarks) Only (No Longer Done per Dr Gentry)
Vascular Imaging: (CT/CTA/Perfusion)

_____ Stroke Deluxe: (Acute Stroke Workup) Includes: CTA head/neck/arch, CT perfusion, CT head w/o & w/ _____ Total Cerebrovascular: (Stenosis, Trauma, Unknown Bleed) Includes: CTA head/neck/arch, CT perfusion, CT head w/o & w/ _____ CTA Head Only: (Cerebrovascular Disease, Unknown Bleed) ___ With Perfusion ___ Without Perfusion
Orbit: (non-traumatic)
_____ Routine _____ Vascular Mass or CC-Fistula _____ With Valsalva _____ Dynamic Multipositional
Temporal Bone: (adult or peds)

____ W/O ____ W/ ____ Both ____ Vascular Mass
Includes: CTA head, CT head w/o & w/, +/- perfusion _____ CTA Neck Only: (Cerebrovascular Disease) Includes: CTA neck and arch _____ CT Venography: _____ Head _____ Head & Neck
Neck Nasopharynx Larynx:

_____ Routine _____ Salivary Gland Calculi (W/O & W/) _____ Vascular Mass _____ Parathyroid Adenoma _____ Brachial Plexus _____ _____
Includes: CTV head +/- neck, CT head w/o & w/ _____ Aneurysm (Hi-Res COW): (Nontraumatic SAH, Known Aneurysm) Includes: CTA head, CT head w/o & w/, no perfusion _____ Ala Carte Studies:
CTA: _____ Head Perfusion: _____ Yes
Neck & Arch No
_____ Add on Neck Options
_____ Puffed Cheek _____ Valsalva

_____ Vocalization _____ Perfusion CT
CT Perfusion (Levels Coverage)
Acute Stroke: _____ Carotid Stenosis: _____ Posterior Fossa: (Vertebrobasilar Insufficiency)
_____
Other Protocol:
Table of Contents:
Page # 5 8 11 13 17 21 24 27 33 34 36 27 33 34 36 37 43 37 43 44 44 48 48 52 52 53 53 59 61 61 62 62 66 66 70 70 75 75 81 82 Protocol 1.1 1.2 1.3 11.1 & 11.2 11.3 & 11.4 11.5 & 11.6 11.7 & 11.8 2.1 2.2 2.3 2.4 12.1 &12.2 12.3 & 12.4 12.5 & 12.6 12.7 & 12.8 2.5a 2.5b 12.9 & 12.10 12.9 & 12.10 1.5 11.9 & 11.10 2.6 12.11 & 12.12 1.10 11.11 & 11.12 2.7 12.13 & 12.14 2.8 2.9 12.16 & 12.17 2.10 12.18 & 12.19 2.11 12.20 & 12.21 2.12 12.22 & 12.23 3.1 3.2 3.1 3.3 Exam Adult Head Routine Helical Adult Head Helical Scan with Angled Axial Reformations Adult Head Axial Pediatric Head Routine Helical Pediatric Head Helical Scan with Angled Axial Reformations Pediatric Head Axial Pediatric Head Trauma Orbit Routine Orbit W ith and W ithout Valsalva Orbit Vascular Mass or Carotid-Cavernous Fistula Orbit Dynamic EOM Movements Pediatric Orbit Routine Pediatric Orbit W ith and W ithout Valsalva Pediatric Orbit Vascular Mass or Carotid-Cavernous Fistula Pediatric Orbit Dynamic EOM Movements Maxillofacial Trauma Routine Maxillofacial Trauma Routine plus 3D Pediatric Maxillofacial Trauma Routine Pediatric Maxillofacial Trauma Routine plus 3D 3D CT Craniosynostosis, Congenital Facial Anomaly Pediatric 3D CT Craniosynostosis, Congenital Facial Anomaly Pituitary Gland and Cavernous Sinus Pediatric Pituitary Gland and Cavernous Sinus Stealth Stereotactic Head (W hole Brain Treatment Planning) Pediatric Stealth Stereotactic Head (W hole Brain Treatment Planning) Sinuses Diagnostic Pediatric Sinuses Diagnostic Sinuses Follow-up Adult ENT Sinus Sinuses Conbined Diagnostic and Landmark Pediatric Sinuses Conbined Diagnostic and Landmark Temporal Bone and Posterior Fossa (W/O Contrast) Pediatric Temporal Bone and Posterior Fossa (W /O Contrast) Temporal Bone and Posterior Fossa (W/O and W Contrast) Pediatric Temporal Bone and Posterior Fossa (W /O and W Contrast) Temporal Bone Vascular Mass Pediatric Temporal Bone Vascular Mass Neck Routine Neck Feet First Neck Salivary Gland Neck Vascular Mass
Table of Contents (continued):

Page # 84 86 75 75 81 82 86 84 90 90 91 93 94 95 97 100 103 106 107 111 112 116 120 124 107 111 112 116 120 124 128 129 130 131 132 138 139 140 141 142 143 Protocol 3.5 3.4 13.1 13.2 13.1 13.3 3.4 13.5 3.1 13.1 3.5 7.5 7.6 7.1 13.5 17.5 17.1 7.2 1.6 & 3.7 1.6a 1.7 1.8 3.8 1.9 & 3.9 11.16 & 11.17 11.16 & 11.17 11.18 & 11.19 11.20 & 11.21 11.22 & 11.23 11.24 & 11.25 Exam Neck Add on Options Neck Parathyroid Adenoma Pediatric Neck Routine Pediatric Neck Feet First Pediatric Neck Salivary Gland Pediatric Neck Vascular Mass Pediatric Neck Parathyroid Adenoma Pediatric Neck Add on Options Brachial Plexus Adult Brachial Plexus Pediatric Cervical Spine Adult Thoracic Spine Feet First Adult Thoracic Spine Head First Adult Lumbar Spine Feet First Adult Cervical Spine Pediatric Thoracic Spine Pediatric Lumbar Spine Pediatric Stealth (Stereotactic) Spine Vascular Imaging: Stroke Deluxe (Acute Stroke W orkup) Vascular Imaging: Total Cerebrovascular Vascular Imaging: CTA Head Only (Stenosis, Unknown Bleed) Vascular Imaging: Aneurysm (Hi-Res COW ) (Non-traumatic SAH, Known Aneurysm) Vascular Imaging: CTA Neck Only (Cerebrovascular Disease) Vascular Imaging: CT Venography Pediatric Vascular Imaging: Stroke Deluxe (Acute Stroke Workup) Pediatric Vascular Imaging: Total Cerebrovascular Pediatric Vascular Imaging: CTA Head Only (Stenosis, Unknown Bleed) Pediatric Vascular Imaging: Aneurysm(Hi-Res COW )(Non-trauma SAH, Known Aneurysm) Pediatric Vascular Imaging: CTA Neck Only (Cerebrovascular Disease) Pediatric Vascular Imaging: CT Venography Appendix #1 CTA Head: 2D Thin and Thick Slab Reformations Appendix #2: CTA Neck: 2D-Reformations Appendix #3: CT Perfusion Protocol Appendix #4: CT Perfusion Coverage Appendix #5: CT Perfusion Analysis Instructions Appendix #6: Neck CT Contrast Timing for Routine Neck CT Appendix #7: 64 Slice Scanner Prioity Appendix #8: CT Scanner Type Appendix #9: CT Scanner Limits Appendix #10: Direction and Naming of 2D-Reformations Appendix: #11 Combined Neuro and Body Contrast Studies
Scanner Nomenclature:
Scanner Location CTI 1 CTI 2 CTI 3 CTI - 4 ER CT-RP East
# of Slices 16 4 16 64 64 8 8
Maximum mA at 120 kV 800 440 800 800 800 440 440
Scanner Name Lightspeed Xtra LightSpeed 16 LightSpeed 16 Pro LightSpeed VCT 64 LightSpeed VCT 64 LightSpeed 8 LightSpeed 8
Naming Convention in this Protocol Book LS Xtra LS 16 LS 16 Pro LS VCT 64 LS VCT 64 LS 8 LS 8
Adult Head: Routine (Helical Mode)

Billing:
(Protocol # 1.1)
1. CT Head without, or with, or without and with 2. Contrast if used 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 patients 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 patients 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 Preferred 20 cm (Range 18-22) 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
Setup:
DFOV: Contrast:
Other Info:
Head: Helical Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.5 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 120 200-660 2.8 530 22 Soft 80/25 Full 22 Bone Plus 3000/300 Full 2.5 1.25
Non-Contrast
CT 2
GE LS 16 Helical 0.6 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 120 130-440 2.8 350 22 Soft 80/25 Full 22 Bone Plus 3000/300 Full 2.5 1.25
CT 3
GE LS 16 Pro Helical 0.4 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 120 200-660 2.8 530 22 Soft 80/25 Full 22 Bone Plus 3000/300 Full 2.5 1.25
CT 4 & ER CT
GE LS VCT 64 Helical 0.4 20 16 0.531 10.62 64 x 0.625 5 2.5 Head 120 190-620 2.8 500 22 Soft 80/25 Full 22 Bone Plus 3000/300 Full 2.5 1.25
East & RP CT
Head: Helical Adult

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 5 2.5 Head 100 210-700 3.3 570 22 Soft 90/30 Full 22 Bone Plus 3500/350 Full 2.5 1.25
East & RP CT
Adult Head:
Billing:
Helical Scan with Angled Axial Reformations (Protocol # 1.2)
1. CT Head without, or with, or without and with 2. Contrast if used 1. Use this protocol when the head cannot be properly positioned for a routine helical head scan. Example: when you cannot move the patients 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. Preferred 20 cm (Range 18-22) 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 1. 2D-Reformations a. Axial Soft Tissue: 5 mm thick with an interval of 2.5 mm 2.5 mm thick with an interval of 1.25 mm b. Axial Bone:
Setup:
DFOV: Contrast:
Other Info:
Head: Helical Scan with Angled Axial Reformations - Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 1.25 0.65 Head 120 170-550 5.6 440 22 Soft 80/25 Plus
Non-Contrast
CT 3
GE LS 16 Pro Helical 0.5 10 16 0.562 5.625 16 x 0.625 1.25 0.65 Head 120 160-530 5.6 420 22 Soft 80/25 Plus
CT 2
GE LS 16 Helical 0.6 10 16 0.562 5.625 16 x 0.625 1.25 0.65 Head 120 130-440 5.6 350 22 Soft 80/25 Plus
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.65 Head 120 150-500 5.6 400 22 Soft 80/25 Full IQ Enhance 22 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
22 Bone Plus 3000/300 Plus 0.625 0.375
22 Bone Plus 3000/300 Plus 0.625 0.375
22 Bone Plus 3000/300 Plus 0.625 0.375
22 Bone Plus 3000/300 Plus 1.25 0.75
10
Head: Helical Scan with Angled Axial Reformations - Adult

CT 1
Contrast
CT 3
CT 2
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.65 Head 100 210-700 6.6 570 22 Soft 90/30 Full IQ Enhance 22 Bone Plus 3500/350 Full IQ Enhance 0.625 0.312
East & RP CT
22 Bone Plus 3500/350 Plus 0.625 0.375
22 Bone Plus 3500/350 Plus 0.625 0.375
22 Bone Plus 3500/350 Plus 0.625 0.375
22 Bone Plus 3500/350 Plus 1.25 0.75
11
Adult Head: (Axial Mode)

Billing:
(Protocol # 1.3)
1. CT Head without, or with, or without and with 2. Contrast if used 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 patients 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). 4. Start scans at the bottom of C1 and scan through the top of the head Preferred 20 cm (Range 18-22) 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
Setup:
DFOV: Contrast:
Other Info:
12
Head: Axial Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Number of Images per Rotation Detector Configuration Slice Thickness (mm) Scan FOV kV mA Recon 1: DFOV Recon Type WW/ WL Recon 2: DFOV Recon Type WW/ WL Slice Thickness (mm) GE LS Xtra Axial 0.7 10 16 2i 16 x 0.625 5 Head 120 670 22 Soft 80/25 22 Bone Plus 3000/300 2.5
Non-Contrast
CT 2
GE LS 16 Axial 0.9 10 16 2i 16 x 0.625 5 Head 120 420 22 Soft 80/25 22 Bone Plus 3000/300 2.5
CT 3
GE LS 16 Pro Axial 0.6 10 16 2i 16 x 0.625 5 Head 120 630 22 Soft 80/25 22 Bone Plus 3000/300 2.5
CT 4 & ER CT
GE LS VCT 64 Axial 0.6 10 16 2i 16 x 0.625 5 Head 120 630 22 Soft 80/25 22 Bone Plus 3000/300 2.5
East & RP CT
Head: Axial Adult

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Axial 0.8 10 16 2i 16 x 0.625 5 Head 100 670 22 Soft 90/30 22 Bone Plus 3500/350 2.5
East & RP CT
13
Pediatric Head: Routine (Helical Mode)

(Protocol # 11.1 & 11.2)
Billing:
(< 6 years of age)
1. CT Head without, or with, or without and with 2. Contrast if used 1. Supine, AP and lateral scouts, no gantry angle 2. Helical mode should be used routinely for pediatric head CT scans. Only use axial mode when you cannot move the patients 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 patients 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 Preferred 16 cm (Range 14-18 cm) 1. 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec 2. Begin scanning as soon as contrast injection is finished 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)
Setup:
Preferred: Contrast:
Patient Age:
Other Info:
14
Head: Helical Pediatric Child (3 6 yr)

CT 1
Non-Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.4 20 16 0.531 10.62 64 x 0.625 5 2.5 Small Head 100 160-640 2.6 480 22 Soft 80/25 Full 22 Bone Plus 3000/300 Full 2.5 1.25
East & RP CT
15
Head: Helical Pediatric Child (3 6 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 5 2.5 Small Head 80 170-675 3.0 510 22 Soft 80/25 Full 22 Bone Plus 3000/300 Full 2.5 1.25
East & RP CT
16
Head: Helical Pediatric Infant (0 3 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.5 10 16 0.562 5.625 16 x 0.625 2.5 1.5 Head 80 140-675 3.3 460 20 Standard 80/25 Plus 20 Bone Plus 3000/300 Full 2.5 1.25
Non-Contrast or Contrast
CT 2
GE LS 16 Helical 0.7 10 16 0.562 5.625 16 x 0.625 2.5 1.5 Head 80 80-390 3.3 260 20 Standard 80/25 Plus 20 Bone Plus 3000/300 Full 2.5 1.25
CT 3
GE LS 16 Pro Helical 0.4 10 16 0.562 5.625 16 x 0.625 2.5 1.5 Head 80 140-675 3.3 460 20 Standard 80/25 Plus 20 Bone Plus 3000/300 Full 2.5 1.25
CT 4 & ER CT
GE LS VCT 64 Helical 0.4 20 16 0.531 10.62 64 x 0.625 2.5 1.5 Small Head 80 130-640 3.3 430 20 Standard 80/25 Plus 20 Bone Plus 3000/300 Full 2.5 1.25
East & RP CT
GE LS 8 Helical 0.8 10 8 0.625 6.25 8 x 1.25 2.5 1.5 Head 80 80-390 3.3 260 20 Standard 80/25 Plus 20 Bone Plus 3000/300 Full 2.5 1.25
17
Pediatric Head:
Billing:
Helical Scan with Angled Axial Reformations (< 6 years of age)
(Protocol # 11.3 & 11.4)

1. CT Head without, or with, or without and with 2. Contrast if used 1. Use this protocol when the head cannot be properly positioned for a routine helical head scan. Example: when you cannot move the patients 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. Preferred 16 cm (Range 14-18 cm) 1. 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec 2. Begin scanning as soon as contrast injection is finished 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: 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
Setup:
DFOV: Contrast:
Patient Age:
18
Head: Helical Scan with Angled Axial Reformations - Pediatric Child (3 6 yr)
CT 1
Non-Contrast
CT 3
CT 2
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 0.625 0.312 Small Head 100 120-510 5.2 380 22 Soft 80/25 Full IQ Enhance 22 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
22 Bone Plus 3000/300 Plus 0.625 0.375
22 Bone Plus 3000/300 Plus 0.625 0.375
22 Bone Plus 3000/300 Plus 0.625 0.375
22 Bone Plus 3000/300 Plus 1.25 0.75
19
Head: Helical Scan with Angled Axial Reformations - Pediatric Child (3 6 yr)
CT 1
Contrast
CT 3
CT 2
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 0.625 0.312 Small Head 80 170-675 6.0 510 22 Soft 80/25 Full IQ Enhance 22 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
22 Bone Plus 3000/300 Plus 0.625 0.375
22 Bone Plus 3000/300 Plus 0.625 0.375
22 Bone Plus 3000/300 Plus 0.625 0.375
22 Bone Plus 3000/300 Plus 1.25 0.75
20
Head: Helical Scan with Angled Axial Reformations - Pediatric Infant (0 3 yr)
CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 0.625 0.375 Head 80 110-570 6.6 370 20 Standard 80/25 Plus
CT 3
GE LS 16 Pro Helical 0.5 10 16 0.562 5.625 16 x 0.625 0.625 0.375 Head 80 110-550 6.6 360 20 Standard 80/25 Plus
CT 2
GE LS 16 Helical 0.7 10 16 0.562 5.625 16 x 0.625 0.625 0.375 Head 80 80-390 6.6 260 20 Standard 80/25 Plus
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 0.625 0.312 Small Head 80 100-520 6.6 340 20 Standard 80/25 Full IQ Enhance 20 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
20 Bone Plus 3000/300 Plus 0.625 0.375
20 Bone Plus 3000/300 Plus 0.625 0.375
20 Bone Plus 3000/300 Plus 0.625 0.375
20 Bone Plus 3000/300 Plus 1.25 0.75
21
Pediatric Head: (Axial Mode)

Billing: Setup:
(Less than 6 years of age) (Protocol # 11.5 & 11.6)
1. CT Head without, or with, or without and with 2. Contrast if used 1. Supine, AP and lateral scouts 2. Helical mode should be used routinely for pediatric head CT scans. Only use axial mode when you cannot move the patients 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). 4. Start scans at the bottom of C1 and scan through the top of the head Preferred 16 cm (Range 14-18 cm) 1. 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec 2. Begin scanning as soon as contrast injection is finished 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)
DFOV: Contrast: Patient Age:
Other Info:
22
Head: Axial Pediatric Child (3 6 yr)

CT 1
Non-Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Axial 0.6 10 16 2i 16 x 0.625 5 Small Head 100 600 22 Soft 80/25 22 Bone Plus 3000/300 2.5
East & RP CT
Head: Axial Pediatric Child (3 6 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Axial 0.8 10 16 2i 16 x 0.625 5 Small Head 80 600 22 Soft 80/25 22 Bone Plus 3000/300 2.5
East & RP CT
23
Head: Axial Pediatric Infant (0 3 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Number of Images per Rotation Detector Configuration Slice Thickness (mm) Scan FOV kV mA Recon 1: DFOV Recon Type WW/ WL Recon 2: DFOV Recon Type WW/ WL Slice Thickness (mm) GE LS Xtra Axial 0.6 10 16 2i 16 x 0.625 5 Head 80 660 20 Standard 80/25 20 Bone Plus 3000/300 2.5
CT 2
GE LS 16 Axial 0.8 10 16 2i 16 x 0.625 5 Head 80 400 20 Standard 80/25 20 Bone Plus 3000/300 2.5
CT 3
GE LS 16 Pro Axial 0.5 10 16 2i 16 x 0.625 5 Head 80 640 20 Standard 80/25 20 Bone Plus 3000/300 2.5
CT 4 & ER CT
GE LS VCT 64 Axial 0.5 10 16 2i 16 x 0.625 5 Small Head 80 640 20 Standard 80/25 20 Bone Plus 3000/300 2.5
East & RP CT
GE LS 8 Axial 0.8 10 8 2i 8 x 1.25 5 Head 80 400 20 Standard 80/25 20 Bone Plus 3000/300 2.5
24
Pediatric Head:
Billing:
(Trauma) (< 6 y/o) (with or without 3D CT) (Protocol # 11.7 & 11.8)
1. CT Head without 2. 3D CT Head if done 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 patients 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. Preferred 16 cm (Range 14-18 cm) 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)
Setup:
DFOV: Patient Age:
Contrast: Other Info:
1. None 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 aters type view = rotate horizontally for 3600 (note: to get a Waters type projection rotate the patients 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!
25
Head Trauma: Helical Pediatric Child (3 6 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.5 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 100 170-680 2.6 510 22 Soft 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75
Non-Contrast
CT 2
GE LS 16 Helical 0.6 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 100 110-420 2.6 340 22 Soft 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75
CT 3
GE LS 16 Pro Helical 0.4 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 100 170-680 2.6 510 22 Soft 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75
CT 4 & ER CT
GE LS VCT 64 Helical 0.4 20 16 0.531 10.62 64 x 0.625 5 2.5 Small Head 100 160-640 2.6 480 22 Soft 80/25 Full 22 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625
East & RP CT
GE LS 8 Helical 0.7 10 8 0.625 6.25 8 x 1.25 5 2.5 Head 100 110-420 2.6 330 22 Soft 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75
26
Head Trauma: Helical Pediatric Infant (0 3 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.5 10 16 0.562 5.625 16 x 0.625 2.5 1.5 Head 80 140-680 3.3 460 20 Standard 80/25 Plus 20 Bone Plus 3000/300 Plus 1.25 0.75
Non-Contrast
CT 2
GE LS 16 Helical 0.7 10 16 0.562 5.625 16 x 0.625 2.5 1.5 Head 80 80-390 3.3 260 20 Standard 80/25 Plus 20 Bone Plus 3000/300 Plus 1.25 0.75
CT 3
GE LS 16 Pro Helical 0.4 10 16 0.562 5.625 16 x 0.625 2.5 1.5 Head 80 140-680 3.3 460 20 Standard 80/25 Plus 20 Bone Plus 3000/300 Plus 1.25 0.75
CT 4 & ER CT
GE LS VCT 64 Helical 0.4 20 16 0.531 10.62 64 x 0.625 2.5 1.5 Small Head 80 130-640 3.3 430 20 Standard 80/25 Plus 20 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625
East & RP CT
GE LS 8 Helical 0.8 10 8 0.625 6.25 8 x 1.25 2.5 1.5 Head 80 80-390 3.3 260 20 Standard 80/25 Plus 20 Bone Plus 3000/300 Plus 1.25 0.75
27
Orbit:
Billing: Setup:
(Routine) (Protocol Adult: # 2.1 Pediatric: # 12.1 & 12.2)

1. CT Orbit without, or with, or with and without 2. Contrast if used 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 Preferred 14 cm (Range 14-16 cm) 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. 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)
DFOV: Contrast:
Patient Age:
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.
28
Orbit: Routine Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Head 120 160-550 5.6 440 18 Standard 300/0 Plus
Non-Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Head 120 150-500 5.6 400 18 Standard 300/0 Full IQ Enhance 18 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625 18 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75 18 Bone Plus 3000/300 Plus 0.625 0.375
18 Bone Plus 3000/300 Plus 1.25 0.75
29
Smart Prep
Prep Over Cavernous Sinus mA 80 Monitoring Delay (sec) 10.0 Monitoring ISD (sec) 2.0 Enhancement Threshold 50 Diagnostic Delay (sec) 12.0
Orbit: Routine Adult

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
18 Bone Plus 3500/350 Plus 1.25 0.75
30
Orbit: Routine Pediatric Child (3 6 yr)

CT 1
Non-Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Small Head 100 120-510 5.2 380 18 Standard 300/0 Full IQ Enhance 18 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625 18 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
31
Smart Prep
Prep Over Aortic Arch mA 40 Monitoring Delay (sec) 10.0 Monitoring ISD (sec) 2.0 Enhancement Threshold 50 Diagnostic Delay (sec) 6.0
Orbit: Routine Pediatric Child (3 6 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) 18 Bone Plus 3000/300 Plus 1.25 0.75 18 Bone Plus 3000/300 Plus 0.625 0.375 18 Bone Plus 3000/300 Plus 1.25 0.75 18 Bone Plus 3000/300 Plus 0.625 0.375 GE LS Xtra Helical 0.7 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Head 80 160-650 6.0 510 18 Standard 300/0 Plus
Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Small Head 80 170-675 6.0 510 18 Standard 300/0 Full IQ Enhance
East & RP CT
18 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625 18 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
18 Bone Plus 3000/300 Plus 1.25 0.75
32
Smart Prep
Orbit: Routine Pediatric Infant (0 3 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) 15 Bone Plus 3000/300 Plus 1.25 0.75 15 Bone Plus 3000/300 Plus 0.625 0.375 15 Bone Plus 3000/300 Plus 1.25 0.75 15 Bone Plus 3000/300 Plus 0.625 0.375 GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Head 80 110-570 5.1 370 15 Standard 300/0 Plus
CT 2
CT 3
CT 4 & ER CT
East & RP CT
15 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625 15 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
15 Bone Plus 3000/300 Plus 1.25 0.75
33
Orbit:
Billing:
(With and Without Valsalva) (Protocol Adult: # 2.2 Pediatric: # 12.3 & 12.4)
1. CT Orbit with or with and without 2. Contrast 1. 2. 3. 4. Monitored Exam: ENT attending or fellow Patient Supine, AP and lateral scouts, no gantry angle Extend the scouts to include aortic arch for smart prep. 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. 5. Ask the patient to look straight ahead and hold their eyes in a very still position. 6. Start the scans at the infraorbital rim and scan through the top of the orbit 7. Always done following either a routine orbit CT with contrast or a vascular mass CT of the orbit with and without contrast Routine Orbit CT with contrast or Orbit Vascular Mass CT without and with contrast 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) Preferred 14 cm (Range 14-16 cm) 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.
Setup Info:
Exam:
Part 1: Part 2:
DFOV: Reformats:
34
Orbit:
Billing: Setup:
(Vascular Mass or Carotid-Cavernous Fistula)

1. CT Orbit (with and without) 2. Contrast 1. 2. 3. 4. Patient Supine, AP and lateral scouts, no gantry angle Extend the scouts to include aortic arch and superior vena cava for smart prep. Always do exam with and without contrast 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. 5. Ask the patient to look straight ahead and hold their eyes in a very still position. 6. Start the scans at the infraorbital rim and scan through the top of the orbit 14 cm (14-16 cm) Part 1: Part 2: Routine Orbit CT without contrast - Standard algorithm (Recon 1) only (no bone algorithm images & no reformats) 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 Post-contrast Orbit CT - Scan as in routine orbit with contrast protocol performing all 3 Recons: standard, bone and, thin bone 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
(Protocol Adult: # 2.3 Pediatric: # 12.5 & 12.6)
DFOV: Exam:
Part 3:
Reformats:
35
Scan Factors for Part 2 only: (Adult and Pediatric)
Smart Prep
Prep Over Superior Vena Cava mA 40 (Adult) 20 (Peds) Monitoring Delay (sec) 10.0 Monitoring ISD (sec) 2.0 Enhancement Threshold 50 Diagnostic Delay (sec) 3.0
Orbit: (Vascular Mass / Carotid-Cavernous Fistula) Adult and Pediatric

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Slice Thickness (mm) Scan FOV kV mA Adults mA Peds < 6 y/o Recon 1: DFOV Recon Type WW/ WL GE LS Xtra Cine then Axial 1.0 20 2.5 Head 100 380 190 18 Standard 350/20
Contrast (Part 2 Only)

CT 3
GE LS 16 Pro Cine then Axial 1.0 20 2.5 Head 100 300 150 18 Standard 350/20
CT 2
GE LS 16 Cine then Axial 1.0 20 2.5 Head 100 300 150 18 Standard 350/20
CT 4 & ER CT
GE LS VCT 64 Cine then Axial 1.0 20 2.5 Head 100 300 150 18 Standard 350/20
East & RP CT
36
Orbit:
Billing:
(Dynamic (EOM Movements) (Protocol Adult: # 2.4 Pediatric: # 12.7 & 12.8)
1. CT Orbit without 1. 2. 3. 4. 5. Monitored Exam: (Only scheduled and done when an ENT attending is available) Always obtained following a Routine Orbit CT without contrast Do only on 64 slice scanner Patient Supine, AP and lateral scouts, no gantry angle 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. 6. Use a head restraint to help the patient hold their head still. 7. Ask the patient to look straight ahead and hold their eyes in a very still position. 8. Start the scans at the infraorbital rim and scan through the top of the orbit 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 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 Preferred 14 cm (Range 14-16 cm) 1. 2. Do the standard 2 x 2 mm 2D-reformations for the routine orbit exam (Part 1) 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)
Setup Info:
Part 1:
Part 2:
DFOV: Reformats:
37
Maxillofacial Trauma:
Billing: Setup:
(Routine)
(Protocol Adult: # 2.5a Pediatric: # 12.9 & 12.10)

1. CT Maxi-face without, or with, or with and without 2. Contrast if used 1. 2. 3. 4. Patient Supine, AP and lateral scouts, no gantry angle Extend the scouts to include aortic arch for smart prep. Remove all metallic and high-density objects from the scanning area. Patient Positioning: Tilt the patients head so that a line connecting the lateral 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 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 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) Preferred 17.2 cm (Range 15-18 cm)
Contrast:
Patient Age:
DFOV:
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. 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 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 noncontrast series.
38
Maxillofacial Trauma Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Head 120 170-550 5.6 440 17.2 Standard 400/50 Plus
Non-Contrast
CT 2
GE LS 16 Helical 0.6 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Head 120 130-440 5.6 350 17.2 Standard 400/50 Plus
CT 3
GE LS 16 Pro Helical 0.5 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Head 120 160-530 5.6 420 17.2 Standard 400/50 Plus
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Head 120 150-500 5.6 400 17.2 Standard 400/50 Full IQ Enhance 17.2 Bone Plus 3000/300 Full IQ Enhance 0.625 0.625
East & RP CT
17.2 Bone Plus 3000/300 Plus 0.625 0.625
17.2 Bone Plus 3000/300 Plus 0.625 0.625
17.2 Bone Plus 3000/300 Plus 0.625 0.625
17.2 Bone Plus 3000/300 Plus 1.25 0.75
39
Smart Prep
Maxillofacial Trauma Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) 17.2 Bone Plus 3500/350 Plus 0.625 0.625 17.2 Bone Plus 3500/350 Plus 0.625 0.625 GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Head 100 240-750 6.6 620 17.2 Standard 450/70 Plus
Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Head 100 210-700 6.6 570 17.2 Standard 450/70 Full IQ Enhance
East & RP CT
17.2 Bone Plus 3500/350 Plus 0.625 0.625
17.2 Bone Plus 3500/350 Full IQ Enhance 0.625 0.625
17.2 Bone Plus 3500/350 Plus 1.25 0.75
40
Maxillofacial Trauma: Pediatric Child (3 6 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Head 100 130-560 5.2 420 17.2 Standard 400/50 Plus
Non-Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Small Head 100 120-510 5.2 380 17.2 Standard 400/50 Full IQ Enhance 17.2 Bone Plus 3000/300 Full IQ Enhance 0.625 0.625
East & RP CT
17.2 Bone Plus 3000/300 Plus 0.625 0.625
17.2 Bone Plus 3000/300 Plus 0.625 0.625
17.2 Bone Plus 3000/300 Plus 0.625 0.625
17.2 Bone Plus 3000/300 Plus 1.25 0.75
41
Smart Prep
Maxillofacial Trauma: Pediatric Child (3 6 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Small Head 80 170-680 6.0 510 17.2 Standard 400/50 Full IQ Enhance
East & RP CT
17.2 Bone Plus 3000/300 Plus 0.625 0.625
17.2 Bone Plus 3000/300 Plus 1.25 0.75
42
Smart Prep
Maxillofacial Trauma: Pediatric Infant (0 3 yr)

CT 1
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Small Head 80 100-520 5.1 340 17.2 Standard 400/50 Full IQ Enhance
East & RP CT
17.2 Bone Plus 3000/300 Plus 0.625 0.625
17.2 Bone Plus 3000/300 Plus 1.25 0.75
43
Maxillofacial Trauma:
(Routine plus 3D)
(Protocol Adult: # 2.5b Pediatric: # 12.9 & 12.10)

Billing: Setup: 1. CT Maxi-face without 2. 3D CT charge 1. Patient Supine, AP and lateral scouts, no gantry angle 2. Remove all metallic and high-density objects from the scanning area. 3. Patient Positioning: Tilt the patients head so that a line connecting the lateral 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 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 Waters type view = rotate horizontally for 360 degrees (note: to get a Waters type projection rotate the patients 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!
Exam:
44
3D CT: (Craniosynostosis, Congenital Facial Anomaly)

Billing: Setup: 1. CT Head without contrast 2. 3D CT Charge 1. 2. 3. 4. Patient Supine, AP and lateral scouts, no gantry angle Use 64 slice scanners if possible Remove all metallic and high-density objects from the scanning area. Patient Positioning: Tilt the patients head so that a line connecting the lateral 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: Contrast:
Preferred 20 cm (Range 18-22 cm) Must include the entire head, face, and mandible 1. Only done without contrast.
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: 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. 2. Do not send the 0.625 mm (Recon 3) bone images to PACS. 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 Waters type view = rotate horizontally for 360 degrees (note: to get a Waters type projection rotate the patients 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!
45
3D CT: (Craniosynostosis, Congenital Facial Anomaly) Non-Contrast Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 120 170-550 2.8 440 22 Standard 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75 22 Bone Plus 3000/300 Plus 0.625 0.375
CT 2
GE LS 16 Helical 0.6 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 120 130-440 2.8 350 22 Standard 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75 22 Bone Plus 3000/300 Plus 0.625 0.375
CT 3
GE LS 16 Pro Helical 0.5 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 120 160-530 2.8 420 22 Standard 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75 22 Bone Plus 3000/300 Plus 0.625 0.375
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 5 2.5 Head 120 150-500 2.8 400 22 Standard 80/25 Full 22 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625 22 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
GE LS 8 Helical 0.7 10 8 0.625 6.25 8 x 1.25 5 2.5 Head 120 130-440 2.8 340 22 Standard 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75
46
3D CT: (Craniosynostosis, Congenital Facial Anomaly) Non-Contrast Pediatric Child (3 6 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 100 140-560 2.6 420 22 Standard 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75 22 Bone Plus 3000/300 Plus 0.625 0.375
CT 2
GE LS 16 Helical 0.7 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 100 100-390 2.6 290 22 Standard 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75 22 Bone Plus 3000/300 Plus 0.625 0.375
CT 3
GE LS 16 Pro Helical 0.5 10 16 0.562 5.625 16 x 0.625 5 2.5 Head 100 130-540 2.6 400 22 Standard 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75 22 Bone Plus 3000/300 Plus 0.625 0.375
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 5 2.5 Small Head 100 120-510 2.6 380 22 Standard 80/25 Full 22 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625 22 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
GE LS 8 Helical 0.8 10 8 0.625 6.25 8 x 1.25 5 2.5 Head 100 100-380 2.6 290 22 Standard 80/25 Full 22 Bone Plus 3000/300 Plus 1.25 0.75
47
3D CT: (Craniosynostosis, Congenital Facial Anomaly) Non-Contrast Pediatric Infant (0 3 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 2.5 1.5 Head 80 110-570 3.3 370 20 Standard 80/25 Full 20 Bone Plus 3000/300 Plus 1.25 0.75 20 Bone Plus 3000/300 Plus 0.625 0.375
CT 2
GE LS 16 Helical 0.7 10 16 0.562 5.625 16 x 0.625 2.5 1.5 Head 80 80-390 3.3 260 20 Standard 80/25 Full 20 Bone Plus 3000/300 Plus 1.25 0.75 20 Bone Plus 3000/300 Plus 0.625 0.375
CT 3
GE LS 16 Pro Helical 0.5 10 16 0.562 5.625 16 x 0.625 2.5 1.5 Head 80 110-550 3.3 360 20 Standard 80/25 Full 20 Bone Plus 3000/300 Plus 1.25 0.75 20 Bone Plus 3000/300 Plus 0.625 0.375
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 2.5 1.5 Small Head 80 100-520 3.3 340 20 Standard 80/25 Full 20 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625 20 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
GE LS 8 Helical 0.8 10 8 0.625 6.25 8 x 1.25 2.5 1.5 Head 80 80-390 3.3 260 20 Standard 80/25 Full 20 Bone Plus 3000/300 Plus 1.25 0.75
48
Pituitary Gland and Cavernous Sinus:

Billing: Setup: 1. 2. 1. 2. 3. 4. CT Head with and without contrast; CT Sella with contrast Contrast Patient Supine, AP and lateral scouts, no gantry angle Extend the scouts to include aortic arch for smart prep. Use 64 slice scanners if possible 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). 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) Head: Pituitary: Preferred 20 cm (Range 18-22 cm) 14 cm
Exam:
DFOV: 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.
49
Scan Factors for Part 2 only: Smart Prep

Pituitary Gland and Cavernous Sinus Adult

CT 1
Contrast
CT 3
CT 2
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Head 100 210-700 6.6 570 14 Standard 350/20 Full IQ Enhance 14 Bone Plus 3500/350 Full IQ Enhance 0.625 0.312
East & RP CT
14 Bone Plus 3500/350 Plus 0.625 0.375
14 Bone Plus 3500/350 Plus 0.625 0.375
14 Bone Plus 3500/350 Plus 0.625 0.375
14 Bone Plus 3500/350 Plus 1.25 0.75
50

Pituitary Gland and Cavernous Sinus Pediatric Child (3 6 yr)

CT 1
Contrast
CT 3
CT 2
CT 4 & ER CT
East & RP CT
14 Bone Plus 3000/300 Plus 0.625 0.375
14 Bone Plus 3000/300 Plus 0.625 0.375
14 Bone Plus 3000/300 Plus 0.625 0.375
14 Bone Plus 3000/300 Plus 1.25 0.75
51

Pituitary Gland and Cavernous Sinus Pediatric Infant (0 3 yr)

CT 1
Contrast
CT 3
CT 2
CT 4 & ER CT
East & RP CT
12 Bone Plus 3000/300 Plus 0.625 0.375
12 Bone Plus 3000/300 Plus 0.625 0.375
12 Bone Plus 3000/300 Plus 0.625 0.375
12 Bone Plus 3000/300 Plus 1.25 0.75
52
Stealth - Stereotactic Head: (Whole Brain Treatment Planning)

Billing: Setup:
1. CT Stereotactic 2. Contrast if used 1. 2. 3. 4. Patient Supine on table top AP and lateral scouts No gantry angle 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 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 3. Begin scanning as soon as contrast injection is finished Mode Time Mode KVP mA Algorithm SFOV DFOV 1. 2. 3. 4. Axial 1 sec 1.25 @ 8i - Interval 10.0 120 250 Standard Head 22 to 25
Contrast:
Scan Factors:
General Notes: If there is ANY patient motion, start the scan over. All images should be networked to ALI Store. Archive only the axial images to the MOD that goes to the surgeon. Technical support is available 24 hours and day, 7 days a week at 800-595-9709.
53
Sinuses (Diagnostic): (Adult and Pediatric)

(Protocol Adult: # 2.7 Pediatric: # 12.13 &12.14)
Billing: Setup: 1. CT Sinus without, or with, or with and without 2. Contrast if used 1. Patient Supine, AP and lateral scouts, no gantry angle 2. Extend the scouts to include aortic arch for smart prep if the exam is to be done with contrast. 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). 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. 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 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) Preferred 14 cm (Range 14-16 cm)
Contrast:
Patient Age:
DFOV:
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 2Dreformats 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.
54
Sinuses (Diagnostic) Adult

CT 1
Non-Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
14 Bone Plus 3000/300 Plus 0.625 0.625
14 Bone Plus 3000/300 Plus 0.625 0.625
14 Bone Plus 3000/300 Plus 0.625 0.625
14 Bone Plus 3000/300 Plus 1.25 0.75
55
Smart Prep
Sinuses (Diagnostic) Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) 14 Bone Plus 3500/350 Plus 0.625 0.625 14 Bone Plus 3500/350 Plus 0.625 0.625 GE LS Xtra Helical 0.5 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Head 100 160-560 8.5 450 14 Standard 450/50 Plus
Contrast
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Head 100 120-430 8.5 340 14 Standard 450/50 Full IQ Enhance
East & RP CT
14 Bone Plus 3500/350 Plus 0.625 0.625
14 Bone Plus 3500/350 Full IQ Enhance 0.625 0.625
14 Bone Plus 3500/350 Plus 1.25 0.75
56
Sinuses (Diagnostic) Pediatric Child (3 6 yr)

CT 1
Non-Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
14 Bone Plus 3000/300 Plus 0.625 0.625
14 Bone Plus 3000/300 Plus 0.625 0.625
14 Bone Plus 3000/300 Plus 0.625 0.625
14 Bone Plus 3000/300 Plus 1.25 0.75
57
Smart Prep
Sinuses (Diagnostic) Pediatric Child (3 6 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
14 Bone Plus 3000/300 Plus 0.625 0.625
14 Bone Plus 3000/300 Plus 1.25 0.75
58
Smart Prep
Sinuses (Diagnostic) Pediatric Infant (0 3 yr)

CT 1
CT 2
CT 3
CT 4 & ER CT
East & RP CT
14 Bone Plus 3000/300 Plus 0.625 0.625
14 Bone Plus 3000/300 Plus 1.25 0.75
59
Sinuses (Follow-up Adult ENT Sinus):

Billing: Setup:
(Protocol: # 2.7)
1. CT Sinus without only (never use this protocol when giving contrast) 1. Patient Supine, AP and lateral scouts, no gantry angle 2. Only use this protocol for ENT and allergy patients with multiple prior diagnostic sinus CT scans 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). 4. Scan from the bottom of maxillary teeth to the top of the frontal sinuses (see below) Preferred 14 cm (Range 14-16 cm) 1. Never give contrast with this protocol 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.
DFOV: Contrast: Reformats:
60
Sinuses: (Follow-up ENT) Adult

CT 1
Non-Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
14 Bone Plus 3000/300 Plus 0.625 0.625
14 Bone Plus 3000/300 Plus 0.625 0.625
14 Bone Plus 3000/300 Plus 0.625 0.625
14 Bone Plus 3000/300 Plus 1.25 0.75
61
Sinuses: (Combined Diagnostic and Landmarx): (Adult and Pediatric)

(Protocol Adult: # 2.9 Pediatric: # 12.16 & 12.17) 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.
62
Temporal Bone: (W/O Contrast) (Protocol Adult: # 2.10 Pediatric: # 12.18 & 12.19)
Billing: 1. Temporal Bone without Setup: 1. Patient Supine, AP and lateral scouts, no gantry angle 2. Only use 16 and 64 slice scanners 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). 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 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) 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, Stenvers, and Pschl planes of each temporal bone using Recon 2 & 3 as source images (below)
63
Temporal Bone Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 2.5 1.25 Head 120 190-610 3.7 490 20 Bone Plus 3000/300 Full 9.6 Bone Plus 3000/300 Plus 0.625 0.375 9.6 Bone Plus 3000/300 Plus 0.625 0.375
Non-Contrast
CT 2
GE LS 16 Helical 0.7 10 16 0.562 5.625 16 x 0.625 2.5 1.25 Head 120 130-420 3.7 340 20 Bone Plus 3000/300 Full 9.6 Bone Plus 3000/300 Plus 0.625 0.375 9.6 Bone Plus 3000/300 Plus 0.625 0.375
CT 3
GE LS 16 Pro Helical 0.5 10 16 0.562 5.625 16 x 0.625 2.5 1.25 Head 120 180-590 3.7 470 20 Bone Plus 3000/300 Full 9.6 Bone Plus 3000/300 Plus 0.625 0.375 9.6 Bone Plus 3000/300 Plus 0.625 0.375
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 2.5 1.25 Head 120 170-560 3.7 450 20 Bone Plus 3000/300 Full 9.6 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312 9.6 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
GE LS 8 Helical
64
Temporal Bone Pediatric Child (3 6 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 2.5 1.25 Head 100 160-630 3.5 480 20 Bone Plus 3000/300 Full 9.6 Bone Plus 3000/300 Plus 0.625 0.375 9.6 Bone Plus 3000/300 Plus 0.625 0.375
Non-Contrast
CT 2
GE LS 16 Helical 0.7 10 16 0.562 5.625 16 x 0.625 2.5 1.25 Head 100 110-420 3.5 330 20 Bone Plus 3000/300 Full 9.6 Bone Plus 3000/300 Plus 0.625 0.375 9.6 Bone Plus 3000/300 Plus 0.625 0.375
CT 3
GE LS 16 Pro Helical 0.5 10 16 0.562 5.625 16 x 0.625 2.5 1.25 Head 100 150-610 3.5 460 20 Bone Plus 3000/300 Full 9.6 Bone Plus 3000/300 Plus 0.625 0.375 9.6 Bone Plus 3000/300 Plus 0.625 0.375
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 2.5 1.25 Small Head 100 140-570 3.5 430 20 Bone Plus 3000/300 Full 9.6 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312 9.6 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
GE LS 8 Helical
65
Temporal Bone Pediatric Infant (0 3 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 2.5 1.25 Head 80 120-630 3.4 430 20 Bone Plus 3000/300 Plus 9.6 Bone Plus 3000/300 Full 0.625 0.375 9.6 Bone Plus 3000/300 Plus 0.625 0.375
Non-Contrast
CT 2
GE LS 16 Helical 0.7 10 16 0.562 5.625 16 x 0.625 2.5 1.25 Head 80 90-400 3.4 290 20 Bone Plus 3000/300 Plus 9.6 Bone Plus 3000/300 Full 0.625 0.375 9.6 Bone Plus 3000/300 Plus 0.625 0.375
CT 3
GE LS 16 Pro Helical 0.5 10 16 0.562 5.625 16 x 0.625 2.5 1.25 Head 80 120-610 3.4 410 20 Bone Plus 3000/300 Plus 9.6 Bone Plus 3000/300 Full 0.625 0.375 9.6 Bone Plus 3000/300 Plus 0.625 0.375
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 2.5 1.25 Small Head 80 120-580 3.4 380 20 Bone Plus 3000/300 Full 9.6 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312 9.6 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312
East & RP CT
GE LS 8 Helical
66
Temporal Bone: (W/O & W/ Contrast) or (W/ Contrast Only):

Billing: Setup: 1. CT Temporal Bone (without and with) 2. Contrast 1. 2. 3. 4. Patient Supine, AP and lateral scouts, no gantry angle: Extend the scouts to include aortic arch for smart prep. Only use 16 and 64 slice scanners 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).
DFOV: Exam:
1. Posterior Fossa: Preferred 20 cm (Range 18-22 cm) 2. TB: 9.6 cm 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.
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) Reformats: 1. Part 1: Do 1 mm by 1 mm 2D-reformats in the coronal, Stenvers, and Pschl 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.
67
Scan Factors: (For Part 2 Only - With Contrast)

Smart Prep
Prep Over Aortic Arch mA 80 Monitoring Delay (sec) 10.0 Monitoring ISD (sec) 3 Enhancement Threshold 50 Diagnostic Delay (sec) 30.0
Temporal Bone: (W/O & W/ Contrast) Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option GE LS Xtra Helical 0.7 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Head 100 230-750 8.8 600 20 Standard 400/40 Plus

CT 3
CT 2
CT 4 & ER CT
East & RP CT
GE LS 8 Helical
68

Smart Prep
Temporal Bone: (W/O & W/ Contrast) Pediatric Child (3 6 yr)

CT 1

CT 3
CT 2
CT 4 & ER CT
East & RP CT
GE LS 8 Helical
69

Smart Prep
Temporal Bone: (W/O & W/ Contrast) Pediatric Infant (0 3 yr)

CT 1

CT 3
CT 2
CT 4 & ER CT
East & RP CT
GE LS 8 Helical
70
Temporal Bone: (Vascular Mass):

Billing: Setup:
(Protocol Adult: # 2.11 Pediatric: #12.20 & 12.21)
1. CT Temporal Bone (without and with) 2. Contrast 1. 2. 3. 4. Patient Supine, AP and lateral scouts, no gantry angle Extend the scouts to include aortic arch for smart prep. Only use 16 and 64 slice scanners 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). 5. The dynamic portion is a monitored exam by an ENT radiologist or ENT Fellow. 1. Posterior Fossa: Preferred 20 cm (Range 18-22 cm) 2 TB: 9.6 cm 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.
DFOV: Exam:
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) 2D Reformats: 1. Part 1: Do 1 mm by 1 mm 2D-reformations in the coronal, Stenvers, and Pschl planes 2. Part 3: Do 2 mm by 2 mm 2D-reformations in the axial, coronal, and sagittal planes
71
Scan Factors for Part 2 only: (Dynamic Contrast Enhanced Exam)

Smart Prep
Prep Over Superior Vena Cava mA 40 Monitoring Delay (sec) 10.0 Monitoring ISD (sec) 2.0 Enhancement Threshold 50 Diagnostic Delay (sec) 3.0
Temporal Bone: (Vascular Mass) Adult & Pediatric

CT 1

CT 2 CT 3
CT 4 & ER CT
East & RP CT
GE LS 8 Cine then Axial
72
Scan Factors for Part 3 only: Temporal Bone: (Vascular Mass) Adult
CT 1

CT 2
CT 3
CT 4 & ER CT
East & RP CT
GE LS 8 Helical
73
Scan Factors for Part 3 only: Temporal Bone: (Vascular Mass) Pediatric Child (3 6 yr)
CT 1

CT 2
CT 3
CT 4 & ER CT
East & RP CT
GE LS 8 Helical
74
Scan Factors for Part 3 only: Temporal Bone: (Vascular Mass) Pediatric Child (0 3yr)
CT 1

CT 2
CT 3
CT 4 & ER CT
East & RP CT
GE LS 8 Helical
75
Neck:
Billing: Setup:
(Routine) (Protocol Adult: # 3.1 Pediatric: # 13.1) (Feet First) (Protocol Adult: # 3.2 Pediatric: # 13.2)
1. CT Neck without, or with, or without and with 2. Contrast if used 1. Patient supine, AP and lateral scouts from sella to mid chest, no gantry angle 2. Extend the scouts to include aortic arch for smart prep. 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 5. 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). 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) Preferred 30 cm (Range 26-30 cm) 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)
DFOV: Contrast:
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
76
Smart Prep
Prep Over Aortic Arch mA 80 Monitoring Delay (sec) 10.0 Monitoring ISD (sec) 3.0 Enhancement Threshold 50 Diagnostic Delay (sec) LS VCT64: 10.0 LS 16 & 16 Pro: 15.0 LS 4 & LS 8: 20.0
Neck: Routine Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.8 20 16 0.562 11.25 16 x 1.25 2.5 1.25 Large 140 280-715 11.4 450 30 Standard 300/35 Full
CT 2
GE LS 16 Helical 1.0 20 16 0.562 11.25 16 x 1.25 2.5 1.25 Large 140 180-380 11.4 290 30 Standard 300/35 Full
CT 3
GE LS 16 Pro Helical 0.6 20 16 0.562 11.25 16 x 1.25 2.5 1.25 Large 140 300-715 11.4 480 30 Standard 300/35 Full
CT 4 & ER CT
GE LS VCT 64 Helical 0.6 20 16 0.531 10.62 64 x 0.625 2.5 1.25 Large Body 140 280-715 11.4 450 30 Standard 300/35 Full IQ Enhance 30 Bone Plus 2500/250 Full IQ Enhance 1.25 0.625 30 Standard 300/35 Full IQ Enhance 1.25 0.625
East & RP CT
GE LS 8 Helical 1.0 10 8 0.625 6.25 8 x 1.25 2.5 1.25 Large 140 200-380 11.4 330 30 Standard 300/35 Full
30 Bone Plus 2500/250 Plus 1.25 0.75 30 Standard 300/35 Plus 1.25 0.75
77
Smart Prep
Neck: Routine Pediatric Child (3 6 yr)

CT 1
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.6 20 16 0.531 10.62 64 x 0.625 2.5 1.25 Head 120 210-630 14.9 380 26 Standard 300/35 Full IQ Enhance 26 Bone Plus 2500/250 Full IQ Enhance 1.25 0.625 26 Standard 300/35 Full IQ Enhance 0.625 0.312
East & RP CT
78
Smart Prep
Neck: Routine Pediatric Infant (0 3 yr)

CT 1
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Head 100 160-620 14.5 330 22 Standard 300/35 Full IQ Enhance 22 Bone Plus 2500/250 Full IQ Enhance 1.25 0.625 22 Standard 300/35 Full IQ Enhance 0.625 0.312
East & RP CT
22 Bone Plus 2500/250 Plus 1.25 0.75
79
Neck: Routine Adult Angled Axials

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Number of Images per Rotation Detector Configuration Slice Thickness (mm) Scan FOV kV mA Recon 1: DFOV Recon Type WW/ WL Recon 2: DFOV Recon Type WW/ WL Slice Thickness (mm) GE LS Xtra Axial 0.7 10 16 4i 16 x 0.625 2.5 Head 120 640 22 Standard 300/35 22 Bone Plus 2500/250 1.25
CT 2
GE LS 16 Axial 0.8 10 16 4i 16 x 0.625 2.5 Head 120 440 22 Standard 300/35 22 Bone Plus 2500/250 1.25
CT 3
GE LS 16 Pro Axial 0.5 10 16 4i 16 x 0.625 2.5 Head 120 720 22 Standard 300/35 22 Bone Plus 2500/250 1.25
CT 4 & ER CT
GE LS VCT 64 Axial 0.5 10 16 4i 16 x 0.625 2.5 Head 120 720 22 Standard 300/35 22 Bone Plus 2500/250 1.25
East & RP CT
Neck: Routine Pediatric Child (3 6 yr) Angled Axials

CT 1
CT 3
CT 2
CT 4 & ER CT
GE LS VCT 64 Axial 0.5 10 16 4i 16 x 0.625 2.5 Head 100 700 22 Standard 300/35 22 Bone Plus 2500/250 1.25
East & RP CT
80
Neck: Routine Non-Contrast or Contrast Pediatric Infant (0 3 yr) Angled Axials

CT 1
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Axial 0.5 10 16 4i 16 x 0.625 2.5 Small Head 80 620 22 Standard 300/35 22 Bone Plus 2500/250 1.25
East & RP CT
81
Neck:
(Salivary Gland) (Protocol Adult: # 3.3 Pediatric: # 13.3)

1. CT Neck (without and with) 2. Contrast 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 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
Billing:
Setup:
Examination:
82
Neck:
Billing: Setup:
(Vascular Mass) (Protocol Adult: # 3.3 Pediatric: # 13.3) 1. CT Neck with and without 2. Contrast 1. 2. 3. 4. Monitored exam (ENT Attending or ENT Fellow) Extend the scouts to include the superior vena cava for smart prep. Patient supine, AP and lateral scouts from sella to mid chest, no gantry angle 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 6. 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). 7. Do angled views if lots of artifact from dental fillings or metal hardware Preferred 30 cm (Range 26-30 cm) Part 1: Limited Non-contrast CT of Neck (scan area per radiologist) 1. Standard algorithm only Part 2: 1. 2. 3. Dynamic Contrast Enhanced Exam -Through the Vascular Mass (as described below) Select eight 2.5 mm scans through the vascular mass (ROI per radiologist) Use 100 kV; 300 mA for adults, 150 mA for peds less than 6 y/o. 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). Standard algorithm only Smart prep over the superior vena cava. Start scanning with the arrival of contrast Adults: Inject 50 ml of 300 mg/ml at 4.0 ml per sec (Injection time = 18.7 sec) Pediatrics: Inject 0.5 ml/lb (1 ml/kg) of 300 mg/ml contrast at 2 ml per sec As soon as all contrast has been injected immediately start Part 3
DFOV: Exam:
4. 5. 6. 7. 8.
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
83
Smart Prep
Prep Over Superior Vena Cava mA 40 (Adult) 20 (Peds) Monitoring Delay (sec) 10.0 Monitoring ISD (sec) 2.0 Enhancement Threshold 50 Diagnostic Delay (sec) 3.0
Scan Factors for Part 2 only: Neck: Vascular Mass (Part 2 Dynamic Scan) Contrast (Part 2 only) Adult and Peds
CT 1
CT 2
CT 3
CT 4 & ER CT
East & RP CT
84
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: - Do after a complete routine neck CT - 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. - No 2D-recons but use standard and bone plus algorithms - Check these scans with the radiologist before the patient leaves the CT scanner 3. Vocalization: - Do after a complete routine neck CT - 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. - No 2D-recons but use standard and bone plus algorithms - Check these scans with the radiologist before the patient leaves the CT scanner 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
85
Scan Factors for Part 2 only: CT Neck Perfusion Study Neck: Perfusion CT (Part 2) Adult & Peds
CT 1
Contrast (Part 2 only)

CT 2
CT 3
CT 4 & ER CT
East & RP CT
86
Neck:
Billing: Setup:
(Parathyroid Adenoma) (Protocol Adult: # 3.4 Pediatric: # 13.4) 1. CT Neck with 2. Contrast 1. Patient Supine, AP and lateral scouts from sella to mid chest, no gantry angle 2. Only do on a 64 slice scanner 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). 4. Remove any dentures or removable teeth; please place the shoulders as low possible 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) 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
DFOV: Exam:
Recons & Reformats:

Part 1: Part 2: A. Sagittal and coronal 2D reformations using standard algorithm images only 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
87
Smart Prep
Neck: Parathyroid Adenoma Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) 22 Bone Plus 3500/350 Plus 1.25 0.75 22 Bone Plus 3500/350 Plus 1.25 0.75 GE LS Xtra Helical 0.6 20 16 0.562 11.25 16 x 1.25 1.25 0.75 Large 120 200-800 11.1 530 22 Standard 400/40 Plus
Contrast
CT 2
GE LS 16 Helical 0.8 20 16 0.562 11.25 16 x 1.25 1.25 0.75 Large 120 120-440 11.1 320 22 Standard 400/40 Plus
CT 3
GE LS 16 Pro Helical 0.5 20 16 0.562 11.25 16 x 1.25 1.25 0.75 Large 120 190-800 11.1 510 22 Standard 400/40 Plus
CT 4 & ER CT
East & RP CT
22 Bone Plus 3500/350 Plus 1.25 0.75
22 Bone Plus 3500/350 Plus 1.25 0.75
88
Smart Prep
Neck: Parathyroid Adenoma Pediatric Child (3 6 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
20 Bone Plus 3000/300 Plus 1.25 0.75
20 Bone Plus 3000/300 Plus 1.25 0.75
89
Smart Prep
Neck: Parathyroid Adenoma Pediatric Infant (0 3 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
18 Bone Plus 3000/300 Plus 1.25 0.75
90
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: Modifications: 1. CT Neck without, or with, or without and with 2. Contrast if used 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)
91
Cervical Spine:
Billing: Setup:
(Adult Routine) (Protocol: # 3.5)
1. CT cervical spine without, or with, or without and with 2. Contrast if used 1. Patient Supine, AP and lateral scouts, no gantry angle 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 patients 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 Preferred 17 cm (Range 16-18 cm)
DFOV:
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 4. Smart prep over the aortic arch. 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) 4. If this is a with & without contrast study: Do not do Recons 2 and 3 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 the bone 0.625 mm images (Recon 2) from the non-contrast series. 5. Do not send the 0.625 mm (Recon 2) bone images to PACS.
92
Smart Prep
Prep Over Aortic Arch mA 80 Monitoring Delay (sec) 10.0 Monitoring ISD (sec) 3.0 Enhancement Threshold 50 Diagnostic Delay (sec) LS VCT64: 20.0 LS Xtra, LS 16 & 16 Pro: 15.0 LS 8: 10.0
Cervical Spine: Routine Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.8 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Large 140 280-715 16.2 450 18 Standard 450/60 Plus
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.6 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Large Body 140 280-715 16.2 450 18 Standard 450/60 Full IQ Enhance 18 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312 18 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
93
Thoracic Spine: (Feet First) (Adult Routine) (Protocol: # 7.5) Thoracic Spine: (Head First) (Adult Routine) (Protocol: # 7.6)
Billing: Setup: 1. CT thoracic spine without, or with, or without and with 2. Contrast if used 1. 2. 3. 4. 5. Patient Supine, AP and lateral scouts, no gantry angle Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used. Non-contrast unless otherwise protocoled Scan from the top of C7 to the bottom of L1 Post myelography patients: Please remember to roll the patient 360 degrees before scanning to distribute the contrast evenly in the spinal canal.
DFOV:
Preferred 17 cm (Range 16-18 cm)
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 4. Smart prep over the aortic arch. 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) 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: 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. 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) 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 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. 4. Do not send the 0.625 mm (Recon 2) bone images to PACS.
94
Smart Prep
Thoracic Spine: Routine Adult

CT 1
CT 2
CT 3
CT 4 & ER CT
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
95
Lumbar Spine:
Billing: Setup:
(Adult Routine) (Protocol: # 7.1)
1. CT lumbar spine without, or with, or without and with 2. Contrast if used 1. 2. 3. 4. 5. Patient Supine, AP and lateral scouts, no gantry angle Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used. Non-contrast unless otherwise protocoled Scan from the top of T12 to the top of S2 Post myelography patients: Please remember to roll the patient 360 degrees before scanning to distribute the contrast evenly in the spinal canal.
DFOV:
Contrast: 1. Injection parameters: 2. Volume: 100 ml of 240 mg/ml nonionic contrast (use 150 ml of 240 mg/ml if a CT of the head will also be obtained). 3. Injection Rate: Adults: 3.5 ml/sec 4. Smart prep over the aortic arch. 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) 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: 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. 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) 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 standard 1.25 mm images (Recon 1) only from the contrast series AND also do 2mm x 2mm reformats using the bone 0.625 mm images (Recon 2) from the non-contrast series. 4. Do not send the 0.625 mm (Recon 2) bone images to PACS.
96
Smart Prep
Lumbar Spine: Routine Adult

CT 1
CT 2
CT 3
CT 4 & ER CT
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
97
Cervical Spine:
Billing: Setup:
(Pediatric Routine) (Protocol: # 13.5)
1. CT cervical spine without, or with, or without and with 2. Contrast if used 1. Patient Supine, AP and lateral scouts, no gantry angle 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 patients 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 5. Post myelography patients: Please remember to roll the patient 360 degrees before scanning in order to distribute the contrast evenly in the spinal canal. Preferred 15 cm (Range 14-18 cm) Injection parameters: Volume: 1 ml/lb (2 ml/kg) of 240 non-ionic contrast. Injection Rate: 2 ml/sec Smart prep over the aortic arch. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanners), 8 sec (16 slice scanners), 10 sec (64 slice scanners)
DFOV:
Contrast: 1. 2. 3. 4. 5.
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) 4. If this is a with & without contrast study: Do not do Recons 2 and 3 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 the bone 0.625 mm images (Recon 2) from the non-contrast series. 5. Do not send the 0.625 mm (Recon 2) bone images to PACS.
98
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)
Smart Prep
Cervical Spine: Routine Pediatric Child (3 6 yr)

CT 1
CT 2
CT 3
CT 4 & ER CT
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
99
Patient Age:
Smart Prep
Cervical Spine: Routine Pediatric Infant (0 3yr)

CT 1
CT 2
CT 3
CT 4 & ER CT
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
100
Thoracic Spine:
Billing: Setup:
1. CT thoracic spine without, or with, or without and with 2. Contrast if used 1. 2. 3. 4. 5. Patient Supine, AP and lateral scouts, no gantry angle Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used. Non-contrast unless otherwise protocoled Scan from the top of C7 to the bottom of L1 Post myelography patients: Please remember to roll the patient 360 degrees before scanning to distribute the contrast evenly in the spinal canal.
DFOV:
Preferred 15 cm (Range 14-18 cm) Injection parameters: Volume: 1 ml/lb (2 ml/kg) of 240 non-ionic contrast. Injection Rate: 2 ml/sec Smart prep over the aortic arch. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanners), 8 sec (16 slice scanners), 10 sec (64 slice scanners) 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)
Contrast: 1. 2. 3. 4. 5. Patient Age:
101
Patient Age:
Smart Prep
Thoracic Spine: Routine Pediatric Child (3 6 yr)

CT 1
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Medium Body 100 150-700 12.8 280 18 Standard 450/60 Full IQ Enhance 18 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312 18 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
102
Patient Age:
Smart Prep
Thoracic Spine: Routine Pediatric Infant (0 3 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Small 80 160-675 11.3 280 18 Standard 450/60 Plus
CT 2
GE LS 16 Helical 0.8 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Small 80 90-400 11.3 170 18 Standard 450/60 Plus
CT 3
GE LS 16 Pro Helical 0.5 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Small 80 150-675 11.3 270 18 Standard 450/60 Plus
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Small Body 80 140-650 11.3 260 18 Standard 450/60 Full IQ Enhance 18 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312 18 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
103
Lumbar Spine:
Billing: Setup:
1. CT lumbar spine without, or with, or without and with 2. Contrast if used 1. 2. 3. 4. 5. Patient Supine, AP and lateral scouts, no gantry angle Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used. Non-contrast unless otherwise protocoled Scan from the top of T12 to the top of S2 Post myelography patients: Please remember to roll the patient 360 degrees before scanning to distribute the contrast evenly in the spinal canal.
DFOV:
Preferred 15 cm (Range 14-18 cm) Injection parameters: Volume: 1 ml/lb (2 ml/kg) of 240 non-ionic contrast. Injection Rate: 2 ml/sec Smart prep over the aortic arch. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanner), 8 sec (16 slice scanners), 10 sec (64 slice scanners) 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)
Contrast: 1. 2. 3. 4. 5. Patient Age:
104
Patient Age:
Smart Prep
Lumbar Spine: Routine Pediatric Child (3 6 yr)

CT 1
CT 2
CT 3
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Medium Body 100 150-700 12.8 280 18 Standard 450/60 Full IQ Enhance 18 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312 18 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
105
Patient Age:
Smart Prep
Lumbar Spine: Routine Pediatric Infant (0 3 yr)

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) Recon 3: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Small 80 160-675 11.3 280 18 Standard 450/60 Plus
CT 2
CT 3
GE LS 16 Pro Helical 0.5 10 16 0.562 5.625 16 x 0.625 1.25 0.75 Small 80 150-675 11.3 270 18 Standard 450/60 Plus
CT 4 & ER CT
GE LS VCT 64 Helical 0.5 20 16 0.531 10.62 64 x 0.625 1.25 0.625 Small Body 80 140-650 11.3 260 18 Standard 450/60 Full IQ Enhance 18 Bone Plus 3000/300 Full IQ Enhance 0.625 0.312 18 Bone Plus 3000/300 Full IQ Enhance 1.25 0.625
East & RP CT
18 Bone Plus 3000/300 Plus 0.625 0.375 18 Bone Plus 3000/300 Plus 1.25
18 Bone Plus 3000/300 Plus 1.25 0.75
106
Stealth (Stereotactic) Spine: (Protocol: # 7.2)

Billing: Setup: 1. CT Stereotactic 2. Contrast if used 1. 2. 3. 4. Patient Supine, AP and lateral scouts No gantry angle Non-contrast unless otherwise protocoled 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. 14 cm (for average patient)
DFOV:
Scan Factors: 1. 2. 3. 4. 5. 6. 7. 8 9. Notes: 1. 2. 3 4. 5. 6. 7. Mode Rotation Detector Config Interval KVP MA Algorithm Scan FOV DFOV = = = = = = = = = Axial 1 sec 1.25 @ 8i 10.0 120 250 Standard Large 14 (for average patient)
If there is ANY patient motion, start the scan over. Do not change the DFOV, centering, or move the patient during the CT exam. Only the axial images are to be archived on the MOD that goes to the surgeon. When IV contrast is needed, wait until it is all injected before starting the scan. No bone windows are needed. No overlapping slices. Technical support is available 24 hours and day, 7 days a week at 800-595-9709.
107
Vascular Imaging: Stroke Deluxe: (Acute Stroke Workup)

(Protocol Adult: # 1.6 & 3.7 Pediatric: # 11.16 & 11.17)
Billing: 1. 2. 3. 4. 1. 2. 3. 4. CT Head with and without CTA Head and Neck with contrast CT Brain Perfusion Contrast Patient Supine, AP and lateral scouts, No Gantry Tilt Extend the scouts to include the aortic arch for smart prep. 16 or 64 slice scanners only 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).
Setup:
DFOV:
Exam: Part 1: Routine Head CT without contrast (helical) Part 2: CTA Head and Neck
1. Scan Area 2. Scan direction 3. Contrast
4. Injection Rate 5. Smart Prep
from the top of the head to the bottom of the carina (see below) scan from top to bottom 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: 150 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase Peds: 1 ml/lb (2 ml/kg) of Iohexol 300 with a 10-25 ml saline chase Adult: 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast transit time) Peds: 2.0-2.5 ml/sec 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. 1. ALI store, CTAW2 and CTAW 3 2-D Reformation Instructions Post Processing:
(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)
108
Smart Prep
CTA: Stroke Deluxe Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) GE LS Xtra Helical 0.6 20 16 0.562 11.25 16 x 1.25 1.25 0.75 Large 120 200-800 11.1 530 22 Standard 400/40 Plus
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
22 Bone Plus 3500/350 Plus 1.25 0.75
22 Bone Plus 3500/350 Plus 1.25 0.75
22 Bone Plus 3500/350 Plus 1.25 0.75
22 Bone Plus 3500/350 Plus 1.25 0.75
109
Smart Prep
CTA: Stroke Deluxe: Pediatric Child (3 6 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
20 Bone Plus 3000/300 Plus 1.25 0.75
20 Bone Plus 3000/300 Plus 1.25 0.75
110
Smart Prep
CTA: Stroke Deluxe: Pediatric Infant (0 3 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
18 Bone Plus 3000/300 Plus 1.25 0.75
111
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.
112
Vascular Imaging: CTA Head Only: (Stenosis, Unknown Bleed):

Billing: 1. 2. 3. 4. 1. 2. 3. 4. CT Head with and without CTA Head with contrast CT Brain Perfusion if done Contrast used if done Patient Supine, AP and lateral scouts, No Gantry Tilt Extend the scouts to include the aortic arch for smart prep. 16 or 64 slice scanners 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).
Setup:
DFOV:
Exam: Part 1: Routine Head CT without contrast (helical) Part 2: CTA Head Only 1. Scan Area 2. Scan direction 3. Contrast
from the top of the head to the bottom of C2 (see below) scan from top to bottom Adult: 80 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase Peds: 1 ml/lb (2 ml/kg) of Iohexol 300 with a 10-25 ml saline chase Adult: 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast transit time) Peds: 2.0-2.5 ml/sec 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. 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
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: Processing:
1. ALI store, CTAW2 and CTAW3 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)
113
Smart Prep
CTA: Head Only Adult

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
22 Bone Plus 3500/350 Plus 1.25 0.75
22 Bone Plus 3500/350 Plus 1.25 0.75
114
Smart Prep
CTA: Head Only: Pediatric Child (3 6 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
20 Bone Plus 3000/300 Plus 1.25 0.75
20 Bone Plus 3000/300 Plus 1.25 0.75
20 Bone Plus 3000/300 Plus 1.25 0.75
20 Bone Plus 3000/300 Plus 1.25 0.75
115
Smart Prep
CTA: Head Only: Pediatric Infant (0 3 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
18 Bone Plus 3000/300 Plus 1.25 0.75
18 Bone Plus 3000/300 Plus 1.25 0.75
18 Bone Plus 3000/300 Plus 1.25 0.75
116
Vascular Imaging: Aneurysm (Hi-Res COW):

Billing: 1. CT Head with and without 2. CTA Head with contrast 3. Contrast 1. 2. 3. 4.
(Nontraumatic SAH, Known Aneurysm)
Setup:
Patient Supine, AP and lateral scouts, No Gantry Tilt Extend the scouts to include the aortic arch for smart prep. 16 or 64 slice scanners 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).
DFOV:
18 cm
Part 2: CTA Head Only 1. Scan Area
Exam: Part 1: Routine Head CT without contrast (helical)
2. Scan direction 3. Contrast 4. Injection Rate 5. Smart Prep

Option: CT 1. 2. 3.
From the top of the lateral ventricles to the bottom of the C2 vertebrae (use Part 1 to select the top slice, see below) scan from top to bottom Adult: 150 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase Peds: 1 ml/lb (2 ml/kg) of Iohexol 300 with a 10-25 ml saline chase Adult: 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast transit time) Peds: 2.0-2.5 ml/sec Over aortic arch (initiate the scan at the entry of contrast in the aortic arch)
Perfusion (see perfusion page for details)
Wait at least 5 min from start of CTA contrast inject before beginning Perfusion Injection. Contrast 40 ml of 370 nonionic contrast (14.8 g Iodine) with 30 ml saline chase 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
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
117
Smart Prep
CTA: Aneurysm (Hi-Res COW) Adult

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
22 Bone Plus 3500/350 Plus 1.25 0.75
22 Bone Plus 3500/350 Plus 1.25 0.75
118
Smart Prep
CTA: Aneurysm (Hi-Res COW): Pediatric Child (3 6 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
20 Bone Plus 3000/300 Plus 1.25 0.75
20 Bone Plus 3000/300 Plus 1.25 0.75
119
Smart Prep
CTA: Aneurysm (Hi-Res COW): Pediatric Infant (0 3 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
18 Bone Plus 3000/300 Plus 1.25 0.75
120
Vascular Imaging: CTA Neck Only:

Billing: Setup:
(Cerebrovascular Disease)

1. CTA Neck/Arch (with contrast) 2. Contrast 1. 2. 3. 4. Patient Supine, AP and lateral scouts, no gantry tilt Extend the scouts to include the aortic arch for smart prep. 16 or 64 slice scanners 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).
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:
80 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase

Adult: On LS 16, LS 8 and LS 4:

120 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase Peds: 1 ml/lb (2 ml/kg) of Iohexol 300 with a 10-25 ml saline chase Adult: 4 ml per sec Peds: 2.0-2.5 ml/sec Over aortic arch (initiate the scan at the entry of contrast in the aortic arch)
121
Smart Prep
CTA: Neck Only Adult

CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) 22 Bone Plus 3500/350 Plus 1.25 0.75 22 Bone Plus 3500/350 Plus 1.25 0.75 GE LS Xtra Helical 0.6 20 16 0.562 11.25 16 x 1.25 1.25 0.75 Large 120 200-800 11.1 530 22 Standard 400/40 Plus
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
22 Bone Plus 3500/350 Plus 1.25 0.75
22 Bone Plus 3500/350 Plus 1.25 0.75
122
Smart Prep
CTA: Neck Only Pediatric Child (3 6 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
20 Bone Plus 3000/300 Plus 1.25 0.75
20 Bone Plus 3000/300 Plus 1.25 0.75
123
Smart Prep
CTA: Neck Only Pediatric Infant (0 3 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
18 Bone Plus 3000/300 Plus 1.25 0.75
124
Vascular Imaging: CT Venography:

(Protocol Adult: #1.9 & 3.9 Pediatric: # 11.24 & 11.25)
Billing: 1. CT Head with and without 2. CTA of Head +/- CTA of Neck with contrast 3. Contrast 1. Patient Supine, AP and lateral scouts, no gantry tilt 2. Extend the scouts to include the 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 below).
Setup:
Exam: Part 1: Routine Head CT without contrast (helical) 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 3. Contrast Adult: 150 ml of Iohexol 240 (36 g Iodine) with a 50 ml saline chase Peds: 1 ml/lb (2 ml/kg) of Iohexol 240 with a 10-25 ml saline chase 4. Injection Rate Adult: 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast
transit time)
5. Smart Prep
Peds: 2.0-2.5 ml/sec 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 Part 3: Routine Head CT with contrast (helical) 1. Wait at least 5 min from start of CTV contrast injection before beginning scan.
125
Smart Prep
CT Venography Adult
CT 1
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Beam Collimation (mm) Detector Rows Pitch Speed (mm/rot) Detector Configuration Slice Thickness (mm) Interval (mm) Scan FOV kV Smart mA/ Auto mA Range Noise Index (Manual mA) Recon 1: DFOV Recon Type WW/ WL Recon Option Recon Option Recon 2: DFOV Recon Type WW/ WL Recon Option Recon Option Slice Thickness (mm) Interval (mm) 22 Bone Plus 3500/350 Plus 1.25 0.75 22 Bone Plus 3500/350 Plus 1.25 0.75 GE LS Xtra Helical 0.6 20 16 0.562 11.25 16 x 1.25 1.25 0.75 Medium 120 200-800 11.1 530 22 Standard 400/40 Plus
Contrast
CT 2
GE LS 16 Helical 0.9 20 16 0.562 11.25 16 x 1.25 1.25 0.75 Medium 120 110-440 11.1 280 22 Standard 400/40 Plus
CT 3
GE LS 16 Pro Helical 0.5 20 16 0.562 11.25 16 x 1.25 1.25 0.75 Medium 120 190-800 11.1 510 22 Standard 400/40 Plus
CT 4 & ER CT
East & RP CT
GE LS 8 Helical 0.9 10 8 0.625 6.25 8 x 1.25 1.25 0.75 Medium 120 120-440 11.1 320 22 Standard 400/40 Plus
22 Bone Plus 3500/350 Plus 1.25 0.75
22 Bone Plus 3500/350 Plus 1.25 0.75
126
Smart Prep
CT Venography: Pediatric Child (3 6 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
20 Bone Plus 3000/300 Plus 1.25 0.75
20 Bone Plus 3000/300 Plus 1.25 0.75
127
Smart Prep
CT Venography: Pediatric Infant (0 3 yr)

CT 1
Contrast
CT 2
CT 3
CT 4 & ER CT
East & RP CT
18 Bone Plus 3000/300 Plus 1.25 0.75
18 Bone Plus 3000/300 Plus 1.25 0.75
128
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. 2. 3. 4. 5. 6. Choose the 1.25 mm slices Select Ref. Detail. Use a window width 600 and window level 200 Choose batch. (You dont need to change slice thickness & rendering mode on image 1st) Do axial, sagittal, and coronal thick-slab MIPs through the entire head. (See examples below) 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.
129
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
130
Appendix # 3
CT Perfusion Protocol: (Specific Instructions):
Billing: Setup: 1. Perfusion and contrast used 1. Patient Supine, AP and lateral scouts, no gantry tilt 2. 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). 3. Usually done in conjunction with a CT/CTA of the Head or CT/CTA of Head/Neck CT Perfusion 1. Scan Type 2. Cine Duration 3. Perfusion Area 4. Contrast 5. Injection Rate patient) 6. Prep Delay 7. Perfusion Slabs DFOV: Cine 45 seconds (next page) 40 ml of 370 nonionic contrast with 30 ml saline chase Adult: 5 ml per sec Pediatric: 3-5 ml per sec (Depends on size of needle and age of 5 seconds Use maximum number (4-8-16) of contiguous 5 mm slabs allowed by each specific CT scanner (use toggle/shuttle mode if possible)
Exam:
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: Adult and Pediatric

CT 1 CT 2
Contrast
CT 3 CT 4 & ER CT East & RP CT
GE LS Xtra
Scanner Scan Type Rotation Time (sec) Detector Coverage (mm) Slice Thickness (mm) Cine Time Between Images Scan FOV kV mA Adults mA Peds < 6 y/o Cine Duration (sec) Recon 1: DFOV Recon Type WW/ WL
Cine 1.0 20 5 0.5 sec Head 80 250 190 45 22 Standard 350/20
GE LS 16 Cine 1.0 20 5 0.5 sec Head 80 200 150 45 22 Standard 350/20
GE LS 16 Pro Cine 1.0 20 5 0.5 sec Head 80 200 150 45 22 Standard 350/20
GE LS VCT 64 Cine 1.0 40 5 0.5 sec Head 80 200 150 45 22 Standard 350/20
GE LS 8 Cine 1.0 20 5 0.5 sec Head 80 200 150 45 22 Standard 350/20
131
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)
132
Appendix # 5: CT Perfusion Analysis Instructions

Suggestions for RO I Placement
133
Suggestions for RO I Placement
Continued on next page
134
135
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 doesnt 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. j. 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. 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. In the lower left port there will be a drop down menu under DFOV called Blood Flow. Change this view to Mean Transit Time.
k. Click compute. This will take a minute. Close Final Settings box. l.
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 isnt any obvious abnormality then you will place your ROIs in the standard places.
136
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 ROIs 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 ROIs 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 ROIs you just created up in view. If it doesnt, 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 ROIs 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 ROIs 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 dont 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 ROIs, 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 ROIs green
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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 ROIs all around periphery and 2 oval ROIs in the center. Tight fit which is the box directly below this, should be checked. There is no need to adjust ROIs. If you want to make them bigger, you can change the thickness. Default thickness is 15 mm and default count of ROIs 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.
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Appendix: 6 Neck CT Contrast Timing Table For Routine Neck CT
Scanner (Age)
Injection Rate
Injection Volume (300 mg/dl)
Volume Saline Chaser
Total Injection Volume
CT Scan Delay after contrast arrival in arch on Smart Prep 20 15
Contrast volume injected from detection by Smart Prep to Start of CT Scan 33.3 - 20 33.3 - 15
Time available to scan from the initiation of the CT scans
64 Slice (Adult) 16 Slice (Adult) 8 Slice (Adult) 64 Slice (Peds) 16 Slice (Peds) 8 Slice (Peds)
3.0 3.0
100 100
50 50
150 150
>13.3 sec >18.3 sec
3.0
100
50
150
10
33.3 - 10 Volume Dependant Volume Dependant Volume Dependant
>23.3 sec
2.0
1 ml/lb
10-25
2.0 2.0
1 ml/lb 1 ml/lb
10-25 10-25
? ?
7 10
? ?
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Appendix: 7 64 Slice Scanner Priorities

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. CTA (High-res COW) CTA (Stroke Deluxe) Temporal Bone CT Any Pediatric CT C-Spine CT T-Spine CT Orbit, Maxiface, Sinus CT Neck-Nasopharynx CT L-Spine CT Brain CT
140
Appendix: 8 CT Scanner Type
Scanner Location CTI 1 CTI 2 CTI 3 CTI - 4 ER CT-RP East
# of Slices 16 16 16 64 64 8 8
Thinnest Slice 0.625 0.625 0.625 0.625 0.625 1.25 1.25
Minimum Scan Time 0.4 sec 0.4 sec 0.4 sec 0.4 sec 0.4 sec 0.5 sec 0.5 sec
Scanner Name LightSpeed Xtra (LS Xtra) LightSpeed 16 (LS 16) LightSpeed 16 Pro (LS 16 Pro) LightSpeed VCT 64 (LS VCT 64) LightSpeed VCT 64 (LS VCT 64) LightSpeed 8 (LS 8) LightSpeed 8 (LS 8)
Weight* Limits 500 400 - 450 400 - 450 500 500 400 - 450 400 - 450
* 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.
141
Appendix: 9 CT Scanner Limits

mA Limits
Scanner Name LS VCT 64 & LS 16 Pro Ped Head All except Ped Head LS 16, & LS 8, Ped Head 170 200 240 300 170 380 200 440 240 420 300 400 Scan FOV All except Ped Head 140 kV 120 kV 100 kV 80 kV 715 800 770 675
Scan FOV
Scanner Name Scan FOV Large Body Medium Body Small Body LS VCT Head Small Head Ped Body Ped Head Large LS 16 Pro, LS 16, & LS 8, Small Head Ped Head Maximum Display FOV (cm) 50 50 32 32 32 32 32 50 25 25 25 Default Display FOV (cm) 50 36 25 25 25 20 20 50 25 25 25
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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 b. Coronal Bone c. Sagittal Bone d. Right Oblique Bone e. Left Oblique Bone f. Axial Soft Tissue g. Coronal Soft Tissue h. Sagittal Soft Tissue i. Right Oblique Soft Tissue j. Left Oblique Soft Tissue k. TB - Right Stenvers l. TB - Right Pschel m. TB - Left Stenvers n. TB - Left Pschel o. CTA - Right Carotid Bifurcation p. CTA - Left Carotid Bifurcation q. CTA - Right ICA Oblique
= = = = = = = = = = = = = = = = = =
AX BONE CO BONE SA BONE RT BONE LT BONE AX ST CO ST SA ST RT ST LT ST RT STENV RT POSCH LT STENV LT POSCH RT Car LT Car RT ICA LT ICA
r.
CTA - Left ICA Oblique
143
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) A. B. CTA Head Only: CTA Head with Perfusion: (only 64 slice scanner) - CTA (Omnipaque 300) - Perfusion (Omnipaque 370) CTA Head & Neck: (only 64 slice scanner) CTA Neck Only: CT Neck: CT Orbit/Maxiface/Sinus/TB: CT Spine (C-T-L): CT Sella: 50 Rate (cc/sec) 4
40 40 80 50 50 50 50 50
3.3 5 2.8 4 3 3 3 4
C. D. E. F. G. H.
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) - Perfusion (Omnipaque 370)
80 40
2.8 5

Neuroradiology CT Protocols

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1

Revised 7/22/09 (Gentry/Ranallo)

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

CT (craniosynostosis, congenital facial anomaly)

Stealth Levels ____________ ___ Thoracic ___ Lumbar ___ Sacral

Spine Levels - Coverage

Stealth (Landmarks) Only (No Longer Done per Dr Gentry)

Vascular Imaging: (CT/CTA/Perfusion)

Temporal Bone: (adult or peds)

Neck Nasopharynx Larynx:

CTA: _____ Head Perfusion: _____ Yes

Neck & Arch No

_____ Add on Neck Options

_____ Puffed Cheek _____ Valsalva

CT Perfusion (Levels Coverage)

Revised 7/22/09 (Gentry/Ranallo)

Revised 7/22/09 (Gentry/Ranallo)

Table of Contents (continued):

Revised 7/22/09 (Gentry/Ranallo)

Scanner Location CTI 1 CTI 2 CTI 3 CTI - 4 ER CT-RP East

Maximum mA at 120 kV 800 440 800 800 800 440 440

Naming Convention in this Protocol Book LS Xtra LS 16 LS 16 Pro LS VCT 64 LS VCT 64 LS 8 LS 8

Revised 7/22/09 (Gentry/Ranallo)

Adult Head: Routine (Helical Mode)

Revised 7/22/09 (Gentry/Ranallo)

Head: Helical Adult

Revised 7/22/09 (Gentry/Ranallo)

Head: Helical Adult

Revised 7/22/09 (Gentry/Ranallo)

Helical Scan with Angled Axial Reformations (Protocol # 1.2)

Revised 7/22/09 (Gentry/Ranallo)

Head: Helical Scan with Angled Axial Reformations - Adult

22 Bone Plus 3000/300 Plus 0.625 0.375

22 Bone Plus 3000/300 Plus 0.625 0.375

22 Bone Plus 3000/300 Plus 0.625 0.375

22 Bone Plus 3000/300 Plus 1.25 0.75

Revised 7/22/09 (Gentry/Ranallo)

Head: Helical Scan with Angled Axial Reformations - Adult

22 Bone Plus 3500/350 Plus 0.625 0.375

22 Bone Plus 3500/350 Plus 0.625 0.375

22 Bone Plus 3500/350 Plus 0.625 0.375

22 Bone Plus 3500/350 Plus 1.25 0.75

Revised 7/22/09 (Gentry/Ranallo)

Adult Head: (Axial Mode)

Revised 7/22/09 (Gentry/Ranallo)

Head: Axial Adult

Head: Axial Adult

Revised 7/22/09 (Gentry/Ranallo)

Pediatric Head: Routine (Helical Mode)

(< 6 years of age)

Revised 7/22/09 (Gentry/Ranallo)

Head: Helical Pediatric Child (3 6 yr)

Revised 7/22/09 (Gentry/Ranallo)

Head: Helical Pediatric Child (3 6 yr)

Revised 7/22/09 (Gentry/Ranallo)

Head: Helical Pediatric Infant (0 3 yr)

Revised 7/22/09 (Gentry/Ranallo)

Helical Scan with Angled Axial Reformations (< 6 years of age)

(Protocol # 11.3 & 11.4)

Revised 7/22/09 (Gentry/Ranallo)

22 Bone Plus 3000/300 Plus 0.625 0.375

22 Bone Plus 3000/300 Plus 0.625 0.375

22 Bone Plus 3000/300 Plus 0.625 0.375

Stealth Levels __________ _ Thoracic _ Lumbar _ Sacral

CTA: _ Head Perfusion: _ Yes

_ Puffed Cheek _ Valsalva