Chest, Abdomen and Pelvis CT Protocols

Oncology: Hypervascular Mets

Chest
ADRENAL MASS Protocol
Chest CT Low Dose Nodule Evaluation
ABDOMEN PELVIS: ROUTINE
Chest CT Lung Cancer Screening
ABDOMEN PELVIS: TRAUMA
Chest CT Routine With Contrast
Abdomen Pelvis: FAST ER Protocol: R/O Acute
Chest CT Without Routine
Appendicitis or Diverticulitis
Chest CTA- Pulmonary Embolism
Abdomen CTA- Aortic Aneurysm -Pre EVT
Chest CTA- Acute Aorta
Abdomen CTA- Aortic Aneurysm –Post EVT
Chest CTA- Aortic Aneurysm -Pre EVT
CT COLONOGRAPHY
Chest CTA Aortic Aneurysm- Post EVT
CT Enterography
Chest CTA- Acute Aorta- Trauma
CT UROGRAM
Chest CT High Resolution
CT UROGRAM LOW DOSE
Coronary CTA Screening History
Renal Mass

Chest, Abdomen and Pelvis Renal CTA

Retroperitoneal Hemorrhage
Chest Abdomen Pelvis: Acute Trauma
Oncology: Hepatoma: (Triphasic Liver CT)
Abdomen and Pelvis
Oncology: Cholangiocarcinoma

CT Cystogram Pancreatic Mass CT

Oncology: Lymphoma CT VENOGRAM PELVIS: Pelvic Venous

Oncology: Hypovascular Mets Congestion

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LOWER EXTREMITIES

CT VENOGRAM LOWER EXTREMITY

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3
Chest

4
Chest CT Low Dose Nodule Evaluation
Typical Indications: Follow up pulmonary nodule(s). Normal or nearly normal radiograph
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Lower cervical spine
Contrast Y N/A Inspiration through both
costophrenic angles
Arterial
Phase N N/A N/A

Venous
Phase N N N/A

Delayed
Phase N N/A N/A

Scan Comments: Low dose: reduce mAs appropriate to patients size: consider
100 kVP/mAS modulation per scanner software. Nodules are lesions <3cm. For
pulmonary masses (>3cm) or hilar enlargement use Chest CT With Contrast
Routine protocol
Scan Comments: Low dose: reduce kVP appropriate to patients size: consider
100 kVP for patients less than 200 lbs/90 kgs. If exam is requested because of
an “abnormal CXR” please have outside CXR and report available for review.
Note: “pulmonary nodules” are lesions <3cm ; pulmonary masses are >3cm. If
scan is for pulmonary mass use Chest CT With Contrast Protocol.

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 Contrast Parameters Parameters
Contrast Type None

Contrast Volume N/A

Saline Flush N/A

Injection Rate N/A

Oral Contrast N/A

Oral Contrast Volume N/A

Reconstruction Soft Tissue Bone/ Thin Sag Cor

Parameters Lung Data

Slice Thickness x 5mm x 5mm x 2mm 3mm 3mm

Recon Spacing 5mm 5mm x x x
Phase #1 #1 1mm 3mm 3mm
#1) Noncontrast #1 #1 #1

Plane Axial Axial Axial Sag Cor

Reconstruction Soft Tissue Lung ST ST ST
Algorithm

Send to PACS PACS Hold PACS PACs

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Chest CT Lung Cancer Screening (USPTF criteria)
1) Adults aged 55-80, with a >30 pack year history of
smoking and who currently smoke or have stopped
smoking in past 15 years
2) Screening should be discontinued once the
individual has not smoked for 15 years or develops a
health problem that significantly limits life
expectancy or the ability or willingness to have
curative lung surgery.
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Lower cervical spine
Contrast Y N/A Inspiration thru both costophrenic
angles
Arterial
Phase N N/A N/A

Venous
Phase N N/A N/A

Delayed
Phase N N/A N/A

Scan Comments:
Guidelines for techniques include:
For BMI < 30 use kVP of 100; mAS < 40; mA 80; goal CTDIvol < 3 mGy

For BMI > 30 use kVP of 120; mAS < 60; goal CTDIvol < 5 mGy

mAS software modulation with ADIR (Toshiba) or CareDose(Siemens) may alter these
parameters.
Additional reported risk factors: documented high radon exposure, occupational
exposures (silica,cadmium,asbestos,arsenic,beryllium,chromium,diesel
fumes,niockel,coal smoke,soot), personal cancer history ( lung cancer, lymphoma, head
and neck), COPD or pulmonary fibrosis, family history lung cancer.

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 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data
Slice Thickness x 1 mm 1 mm 0.5 mm x 2 mm 2 mm NA
Recon Spacing 0.3 mm x2 x2
Phase mm mm
#1) Noncontrast
Plane Axial Axial Axial Sag Cor

Reconstruction Algorithm Soft LUNG LUNG LUNG LUNG N/A

Tissue

Send to PACS PACS Hold PACS PACs N/A

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Chest CT Routine With Contrast
Typical Indications: Evaluate Infection, known or suspected lung cancer, empyema, evaluate
pulmonary mass, hilar enlargement
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non N N/A N/A
Contrast
Arterial N Use Bolus Inspiration Lower cervical spine
Phase Tracking through adrenal glands
Venous N N N/A
Phase
Delayed N N/A N/A
Phase
Scan Comments: Nodules are lesions <3cm. For incidental nodules may be able to use
Noncontrast CT Nodule protocol. For pulmonary masses (>3cm) or hilar enlargement
use Chest CT With Contrast Routine protocol

Contrast Parameters Parameters

Contrast Type Per institution
Contrast Volume 75-80cc
Use 100 cc if combined with abdomen CT
Injection Rate 4-5cc/sec
Oral Contrast N/A
Oral Contrast Volume N/A
Contrast Comments: Scan delay: usual 25 seconds;
Use Bolus Tracking if available

Reconstruction Soft Bone/ Thin Sag Cor 3D/Special

Parameters Tissue Lung Data
Slice Thickness x 5mm x 5mm x 2mm x 3mm x 3mm x NA
Recon Spacing 5mm 5mm 1mm 3mm 3mm
Plane Axial Axial Axial Sag Cor NA

Reconstruction Algorithm Soft Tissue Lung ST ST ST NA

Send to PACS PACS Hold PACS PACS NA

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Chest CT Without Routine
Typical Indications: Evaluate lung nodule(s)
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Lower cervical spine through both
Contrast Y N/A Inspiration costophrenic angles

Arterial
Phase N N/A N/A

Venous
Phase N N N/A

Delayed N N/A N/A

Phase

Scan Comments: Nodules are lesions <3cm. For pulmonary masses (>3cm) or hilar
enlargement use Chest CT With Contrast Routine protocol

Reconstruction Soft Bone/

Thin Data Sag Cor 3D/Special
Parameters Tissue Lung
Slice Thickness x 5mm x 5mm x 2mm x 3mm x 3mm x
NA
Recon Spacing 5mm 5mm 1mm 3mm 3mm
Plane Axial Axial Axial Sag Cor NA
Reconstruction Soft
Lung ST ST ST NA
Algorithm Tissue
Send to PACS PACS Hold PACS PACS NA

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Chest CTA- Pulmonary Embolism
Typical Indications: r/o PE; elevated D-Dimer
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non
Contrast N N/A N/A

Arterial
Use Bolus Lung apex thru both
Phase Y Inspiration
Tracking costophrenic angles
Venous
Phase N N N/A

Delayed
Phase N N/A N/A

Scan Comments: In Pregnant patients confirm Duplex Venous Exam was NEGATIVE PRIOR to CTA; use
low dose protocol; abdominal shielding; informed written consent for radiation during pregnancy;
*oral thin barium for “internal shielding” if time permits. No need to breast pump/discard milk
recommendations for 24 hours unless patient anxious regarding contrast* Pt info sheet regarding
breast feeding available on mxcimaging.com.

Contrast Parameters Parameters

Contrast Type Per institution

Contrast Volume 80cc

Injection Rate 4-5cc/sec

Oral Contrast 450 cc thin standard barium PO ideally 20-30 minutes pre
for pregnant patients only if time allows

450 cc
Oral Contrast Volume

Internal barium shielding provides some protection from scatter

Contrast Comments: radiation to pelvis. Mid and lower abdomen pelvis external lead
shielding will minimize direct beam radiation to pelvis. CTA has
significantly less Fetal dose than standard VQ imaging but has
significantly higher Maternal breast dose.

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 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data
Slice Thickness x 2mm x 5mm x 1mm x 3mm x 3mm x 10 mm thick
Recon Spacing 2mm 5mm 0.5mm 3mm 3mm Coronal MIPS
(or as thin
as scanner
config
allows)
Plane Axial Axial Axial Sag Cor Cor

Reconstruction Soft Tissue Lung ST ST ST ST

Algorithm

Send to PACS PACS Hold PACS PACS PACS

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Chest CTA- Acute Aorta
Typical Indications: R/O Acute Aortic Dissection/ Aneurysm, follow up endovascular stent, aortic
injury
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Top of Aortic Arch to
Contrast N** N/A N/A diaphragm

Arterial Mid cervical spine thru

Phase Y-GATED*** Bolus Tracking Inspiration iliac crests*

Venous * If AbdPel CT ordered

Phase N N N/A for trauma; pause at
diaphragm and continue
with 70 sec delay CT of
AbdPel
Delayed N N/A N/A
Phase

Scan Comments: ** For Acute Chest Pain with specific history of “r/o dissection” include
NonContrast CT to evaluate for acute intramural hematoma. For routine f/u thoracic
aneurysm Noncontrast not needed. Dissections often extend into abdomen or neck-
coverage includes expanded FOV*. For acute symptoms add GATING*** to optimally see
ascending aorta.
Contrast Parameters Parameters
Per institution
Contrast Type

Contrast Volume 100cc

Injection Rate 4-5cc/sec

Oral Contrast N/A

N/A
Oral Contrast Volume

Contrast Comments:

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 Reconstruction Soft Bone/ Thin Data Sag Cor 3D/Special
Parameters Tissue Lung

Slice Thickness x 2mm x 5mm x 1mm x 3mm x 3mm x #3) 3D radial MPR
Recon Spacing 2mm 5mm 0.5mm 3mm 3mm #4) 5mm thick
Phase #1 #1 #2 #2 MIPs in SAG and
#1) Noncontrast #2 #2 COR
#2) Arterial Phase
Plane Axial Axial Axial Sag Cor 3) Radial Range
4) SAG/COR

Reconstruction Soft Lung ST ST ST ST

Algorithm Tissue

Send to PACS PACS 1. To 3D PACS PACs PACs : Reformat

server 3Ds AFTER
2. PACS transferring raw
data to PACS

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Chest CTA- Aortic Aneurysm -Pre EVT
Typical Indications: f/u known or suspected thoracic aneurysm, preop evaluation stent graft
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non N** N/A N/A
Contrast
Arterial Use Bolus Mid cervical spine thru
Y Inspiration
Phase Tracking costophrenic angles
Venous Phase N N N/A
Delayed
Phase N N/A N/A

Scan Comments:
For routine f/u thoracic aneurysm noncontrast not needed.
** For Acute Chest Pain with r/o dissection include NonContrast CT to evaluate for
acute intramural hematoma and GATE the CTA exam. See CTA Acute Aorta
**For POST Endovacular Stent Graft patients add NonContrast phase thru chest/abd
stent graft region

Contrast Parameters Parameters

Contrast Type Per institution
Contrast Volume 75-80cc routine
100 cc if combining with abdomen
Injection Rate 4-5cc/sec
Oral Contrast N/A
Oral Contrast Volume N/A
Contrast Comments:

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 Reconstruction Soft Bone/ Thin Sag
Cor 3D/Special
Parameters Tissue Lung Data

Slice Thickness x 2mm x 5mm x 1mm x 3mm x 3mm x

Recon Spacing 2mm 5mm 0.5mm 3mm 3mm #3) 3D radial MPR
Phase #1 #1 #2 #2 #2 #4) 5mm thick MIPs in
#1) Noncontrast #2 SAG and COR
#2) Arterial Phase

Plane Axial Axial Axial Sag Cor 3) Radial Range

4) SAG/COR

Reconstruction Soft
Lung ST ST ST ST
Algorithm Tissue

1. To
3D PACS : Reformat 3Ds
Send to PACS PACS PACS PACS
server AFTER transferring raw
2. PACS data to PACS

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Chest CTA Aortic Aneurysm- Post EVT
Typical Indications: f/u thoracic aneurysm stent graft
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Top of Aortic Arch thru
Y N/A N/A
Contrast domes of diaphragm
Mid cervical spine thru
Arterial
costophrenic angles
Phase Use bolus
Y Inspiration (if aneurysm extends to
tracking
abdomen include)
Venous
N N N/A
Phase

Delayed
N N/A N/A
Phase

Scan Comments: Include entirety of stented region on noncontrast phase.

For routine f/u thoracic aneurysm only noncontrast phase not needed.
** For Acute Chest Pain with r/o dissection include NonContrast CT to evaluate for acute
intramural hematoma and GATE CTA phase: See CTA Acute Aorta
**For POST Endovacular Stent Graft patients add NonContrast phase thru chest/abd stent graft
region

Contrast Parameters Parameters

Contrast Type Per institution
Contrast Volume 80cc

Injection Rate 4cc/sec

Oral Contrast N/A
Oral Contrast Volume N/A

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 Reconstruction Soft Bone/ Thin Data Sag Cor
Parameters Tissue Lung

Slice Thickness x 2mm x 5mm x 1mm x 3mm x 3mm x

Recon Spacing 2mm 5mm 0.5mm 3mm 3mm
Phase #1 #1 #2 #2
#1) Noncontrast #2 #2
#2) Arterial Phase

Plane Axial Axial Axial Sag Cor

Reconstruction Soft
Lung ST ST ST
Algorithm Tissue

1. To 3D
Send to PACS PACS server PACS PACs
2. PACS

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Chest CTA- Acute Aorta- Trauma
Typical Indications: Severe trauma, Chest pain r/o Acute Aortic Dissection/tear, mediastinal
widening
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non
N N/A N/A N/A
Contrast
Arterial *GATED
Mid-cervical spine thru
Phase Y Use Bolus Inspiration
Iliac Crests
Tracking
Venous
N N N/A
Phase
Delayed
Phase N N/A N/A

Scan Comments: *For acute symptoms add GATING to optimally see ascending aorta;
Gating improves motion artifact at aortic root and ascending aorta. If using Toshiba
Acquillion One may omit gating and use Ultrafast Helical
Contrast Parameters Parameters
Contrast Type Per institution

Contrast Volume 80cc chest CTA only

Injection Rate
Oral Contrast
Oral Contrast Volume
Contrast Comments:
100 cc if combined CAP
4-5cc/sec
N/A
N/A
pancreas/ duodenal/prox SB injury optimally assessed with oral
in UGI tract but do not delay scan for oral contrast

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 Reconstruction Soft Bone/ Thin Data Sag Cor 3D/Special
Parameters Tissue Lung

Slice Thickness x 2mm x 5mm x 1mm x 3mm x 3mm x #3) 3D radial

Recon Spacing 2mm 5mm 0.5mm 3mm 3mm MPR
Phase #1 #1 #2 #2 #4) 5mm thick
#1) Noncontrast #2 #2 MIPs in SAG and
#2) Arterial Phase COR

Plane Axial Axial Axial Sag Cor 3) Radial Range

4) SAG/COR

Reconstruction Soft Tissue Lung ST ST ST ST

Algorithm

Send to PACS PACS 1. To 3D PACS PACS PACS : Reformat

server 3Ds AFTER
2. PACS transferring raw
data to PACS

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Chest CT High Resolution
Typical Indications: Evaluate interstitial lung disease, emphysema, bronchiectasis, asbestosis
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Y
Inspiration
Contrast Supine Helical Lung apices to domes
N/A Expiration
Supine Axial diaphragms
Inspiration
Prone Axials
Arterial
N N/A N/A
Phase
Venous
N N N/A
Phase
Delayed
Phase N N/A N/A

Scan Comments: There are three scans in this protocol: supine inspiration helical, supine
expiration axials, and prone inspiration axials. Every effort must be made to acquire
prone images. Helical first run performed at 5mm x 5mm supine with inspiration.
Second acquisiton is Supine Expiration 1.25mm x 10mm and third is Prone Inspiration
Axials 1.25mm x 10mm.

Reconstruction
Soft Tissue Lung Thin Data Sag/Cor
Parameters
Slice Thickness
1) Helical Run 1) 5mm 1) 5mm 1) 2mm 1) 3mm
2) Supine Hi
2) 1.0mm NA
Res Axial
NA
3) Prone Hi 3) 1.0mm
Res Axial
Reconstruction
Spacing 1) 5mm 1) 5mm 1) 1.0mm 1) 3mm
1) Helical Run
2) 10mm NA
2) Supine Hi
Res Axial 3) 10mm NA
3) Prone Hi
Res Axial
Reconstruction Soft Tissue Bone+ Soft Tissue ST
Algorithm Algorithm
(Hi-Res Lung)
SEND to PACS PACS PACS PACS
#1,#2,#3

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Coronary CTA Screening History

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Chest, Abdomen and Pelvis

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Chest Abdomen Pelvis: Acute Trauma
Typical Indications: Severe trauma, Chest pain r/o Acute Aortic Dissection/tear, mediastinal
widening; abdomen pelvis trauma
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non N N/A N/A
Contrast
ArterialPhase Y GATED Chest CTA Inspiration Mid-cervical spine domes
Use Bolus Tracking diaphragms
Venous Y Abdomen Inspiration Domes diaphragms to lesser
Phase Pelvis trochanters
60-70 seconds
Delayed Y 5 -10 minutes Inspiration Kidneys 5 x 5mm
Phase Bladder 5 x 5mm
Scan Comments: Clamp foley catheter upon transfer to CT from ER.
For acute severe chest trauma add GATING for Chest CTA to optimally see ascending
aorta;
Pause at diaphragm if needed to achieve portal venous phase 70 second delay thru
abdomen/pelvis.
If bladder injury is suspected because of multiple pelvic fractures, you should do CT
cystogram following the routine abdominal CT. You need to actively distend the
bladder in order to exclude bladder injury. Passive filling of the bladder via the I.V.
injection is not sufficient to exclude rupture.
• Inject 200-300 cc of dilute contrast in bladder via Foley catheter by gravity. Dilute
contrast is a 2-3% solution of iodine. (100 cc of Isovue 300 contrast in a 1 liter saline
bag.)
• The Foley catheter must be placed by the trauma or emergency service, who should
have already cleared the patient from possible urethral injury.
• Rescan lower abdomen and pelvis. Check for intraperitoneal extravasation along
gutters and between bowel loops. Check for extraperitoneal extravasation anterior to
the bladder and along the anterior abdominal wall and scrotum. Post-void images are
not necessary.

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 Contrast Parameters Parameters
Contrast Type Isovue 370 if CTA
Isovue 300 if non CTA
Contrast Volume 100 cc
Injection Rate 4-5cc/sec
Oral Contrast N/A
Oral Contrast Volume N/A
Contrast Comments:

Reconstruction Soft Tissue Bone/ Thin Sag Cor

Parameters Lung Data
Slice Thickness x 5mm x 5mm x 2mm 3mm 3mm
Recon Spacing 5mm 5mm x x x
1mm 3mm 3mm

Plane AX AX AX SAG COR

Reconstruction Algorithm ST Lung ST ST ST

Send to PACS PACS To 3D PACs PACs

Server
then
PACs

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Abdomen and Pelvis

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CT Cystogram
This exam is done specifically to rule out bladder rupture.
If bladder injury is suspected because of multiple pelvic fractures or unexplained
acites with history of trauma you should do CT cystogram following the routine
abdominal CT. You need to actively distend the bladder in order to exclude bladder
injury. Passive filling of the bladder via the I.V. injection is not sufficient to exclude
rupture.
• Inject 200-300 cc of dilute contrast in bladder via Foley catheter by gravity drip
40 cm above table. Dilute contrast = 2-3% solution of iodine. (100 cc of Isovue
300 contrast in a 1 liter saline bag.)
• The Foley catheter must be placed by the trauma or emergency service, who
should have already cleared the patient from possible urethral injury.
• Rescan lower abdomen and pelvis at 5mm x 5mm making sure imaging goes
through bottom of symphysis pubis joint. Recon these into ST windows and
reformat images to 3mm x3mm SAG and COR planes.
Check for intraperitoneal extravasation along gutters and between bowel loops. Check
for extraperitoneal extravasation anterior to the bladder and along the anterior
abdominal wall and scrotum. Post-void images are usually not necessary.

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Oncology: Lymphoma
Typical Indications: staging; r/o mets
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non N N/A N/A
Contrast
Arterial N N/A N/A
Phase
Venous Y 60-70 SECS Inspiration Domes diaphragms
Phase thru lesser trochanters
Delayed N < 40 yo Delayed Inspiration Kidneys 5x5
Phase Y > 40 yo kidneys/bladder Bladder 5x5
after 5minutes for
age >40, trauma,
or hematuria
Scan Comments:
Contrast Parameters Parameters
Contrast Type Isovue 300
Contrast Volume 100cc
Injection Rate 3-4cc/sec
Oral Contrast Per institution protocol

Oral Contrast Volume Per institution

Contrast Comments:

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 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data

Slice Thickness x 5mm 5mm 2mm 3mm 3mm NA

Recon Spacing 5mm 5mm 1mm 3mm 3mm

Plane AX AX AX NA COR NA

Reconstruction ST LUNG ST NA ST NA
Algorithm

Send to PACS PACS HOLD PACs PACS NA

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Oncology: Hypovascular Mets
Typical Indications: routine staging breast, ovarian, lung, colon
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non N N/A N/A
Contrast

Arterial N N/A N/A

Phase
Venous Y 60-70 SECS Inspiration Domes diaphragms
Phase thru lesser
trochanters*
Delayed N < 40 yo Delayed Inspiration Kidneys 5x5
Phase Y > 40 yo kidneys/bladder Bladder 5x5
after 5 minutes for
age >40, trauma,
or hematuria
Scan Comments: *Include pelvis during PVP if pelvis CT ordered.
Contrast Parameters Parameters
Contrast Type Isovue 300
Contrast Volume 75-80 cc routine
use 100cc if scanning combined C-A-P
Injection Rate 3-4cc/sec
Oral Contrast Per institution
Oral Contrast Volume Per institution
Contrast Comments:

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 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data

Slice Thickness x 5mm x 5mm x 2mm x 3mm x 3mm x NA

Recon Spacing 5mm 5mm 1mm 3mm 3mm

Plane AX AX AX NA COR NA

Reconstruction ST LUNG ST NA ST NA
Algorithm

Send to PACS PACS HOLD PACs PACS NA

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Oncology: Hypervascular Mets
Typical Indications: Staging: neuroendocrine tumor: islet cell tumor/carcinoid, renal carcinoma,
thyroid, choriocarcinoma, hepatoma, melanoma, sarcoma; leiomyosarcoma
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non
Y N/A Inspiration Liver thru Pancreas
Contrast
Arterial Use Bolus Tracking
Phase Y arterial phase Inspiration Liver
(25-30 SECS)
Venous Domes diaphragms thru
Y 60-70 SECS Inspiration
Phase lesser trochanters
Delayed Delayed kidneys/bladder
Phase N < 40 yo after 5 minutes for age Kidneys 5x5
Inspiration
Y > 40 yo >40, trauma, or Bladder 5x5
hematuria
Contrast Parameters Parameters
Contrast Type Per insitution
Contrast Volume 100cc
Injection Rate 4-5cc/sec

Oral Contrast Per Institution

Per Institution
Oral Contrast Volume
Contrast Comments:

32
 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data

Slice Thickness x 5mm x 5mm x 2mm x 3mm x 3mm x NA

Recon Spacing 5mm 5mm 1mm 3mm 3mm

Plane AX AX AX NA COR NA

Reconstruction ST LUNG ST NA ST NA
Algorithm

Send to PACS PACS HOLD PACs PACS NA

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ADRENAL MASS Protocol
Typical Indications: adrenal mass, biochemical evidence adrenal lesion, elevated
catecholamines/metanephrines; r/o pheochromocytoma
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Highest dome
Contrast Y N/A Inspiration diaphragm thru kidneys

Arterial N/A N/A

Phase N

Venous Y* 60 seconds** Inspiration Same as noncontrast;

Phase Scan thru pelvis if
indication PHEO
Delayed Y* 15 minutes Inspiration Highest dome
Phase diaphragm thru kidneys

Scan Comments: *If noncontrast images demonstrate adrenal lesion <4cm and with
HU < 10 contrast images may not be needed. If the noncontrast images demonstrate
a homogeneous lesion that is less than 10 HU and less than 4cm the lesion is highly
likely to be an adrenal adenoma and no further imaging is necessary. Therefore, the
radiologist should check the noncontrast images prior to proceeding with the
remainder of the study unless evaluation of the entire abdomen and pelvis was
requested for other reasons.
Relative Washout values >40% most c/w benign adenoma (RW= EAV-DAV/EAV).
**Literature specifies 60 sec scan comparison to 15 minute scan: please do not fudge
these scan times.
If scanning for Pheochromocytoma: will need pelvis CT.
Contrast Parameters Parameters
IV Contrast Per Institution

Contrast Volume 75-80 cc

Injection Rate 3-4cc/sec

Oral Contrast Use H20 Protocol

Oral Volume 400 cc H20 pre

400 cc H20 on table
Contrast Comments

34
 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data

Slice Thickness x 3mm 5mm 2mm 3mm 3mm NA

Recon Spacing 3mm 5mm 1mm 3mm 3mm

Plane AX AX AX NA COR NA

Reconstruction ST LUNG ST NA ST NA
Algorithm

Send to PACS PACS HOLD PACs PACS NA

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ABDOMEN PELVIS: ROUTINE
Typical Indications: abdominal pain, mass, r/o abscess, appendicitis, diverticulitis, FUO, acute
pancreatitis
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non
Contrast N N/A N/A

Arterial N/A N/A

Phase N

Venous Y Bolus Tracking (60- Inspiration Domes diaphragms

Phase 70 SECS) thru lesser trochanters

Delayed No < 40 yo Delayed Inspiration Kidneys 5x5

Phase Yes > 40 yo kidneys/bladder Bladder 5x5
after 5-10minutes
for age >40,
trauma, or
hematuria
Scan Comments: Acute Pancreatitis: work-up should be done as routine abdomen.
Noncontrast CT only need if concern for pancreatic hemorrhage.
Contrast: For Pancreatitis cases OPACIFICATION AND DISTENTION OF DUODENUM IS VERY
HELPFUL- drink additional oral contrast immediately before scan and consider placing
patient right side down for 2-3minutes prior to scanning to mobilize contrast into
duodenum.
Contrast Parameters Parameters

Contrast Type Per institution

Contrast Volume 100cc

Injection Rate 3-4cc/sec

Per insitution
Oral Contrast

Per institution
Oral Contrast Volume

Contrast Comments:

36
 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data

Slice Thickness x 5mm x 5mm x 2mm x 3mm x 3mm x NA

Recon Spacing 5mm 5mm 1mm 3mm 3mm

Plane AX AX AX SAG COR NA

Reconstruction ST LUNG ST SAG ST NA

Algorithm

Send to PACS PACS HOLD PACs PACS NA

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ABDOMEN PELVIS: TRAUMA
Typical Indications: ACUTE TRAUMA
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non
Contrast N N/A N/A

Arterial N/A N/A

Phase N

Venous Y 60-70 SECS Inspiration Domes diaphragms thru

Phase lesser trochanters

Delayed Y 5-10 minutes Inspiration Kidneys 5x5

Phase Bladder 5x5

Scan Comments: Clamp foley if present prior to scan. If multiple pelvic fractures and or
bladder injury suspected will need to do a CT Cystogram (See Cystogram Protocol) to
actively distend bladder (passive filling via IV is not sufficient). ALL SERIOUS TRAUMA
PATIENTS INCLUDE PELVIS CT: Abdomen CT only is not option for serious trauma unless
discussed and approved by radiologist.

Contrast Parameters Parameters

Contrast Type Per insitution

Contrast Volume 100cc

Injection Rate 3cc-4cc/sec

No Oral Contrast Delay for Severe Trauma

Oral Contrast If NG Tube already present: Isovue 370/H20 (33cc/900cc)
on way to CT for indication upper abd trauma

Oral Contrast Volume If NG Tube already present: 400cc Isovue 370/H20

ABD PEL CT: TRAUMA
(mix 33ccIsovue/900ccH20) on the way to CT for indication upper
Contrast Comments: abd pancreas/ duodenal/prox SB injury optimally assessed with
oral in UGI tract but do not delay scan for oral contrast.

38
 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data

Slice Thickness x 5mm x 5mm x 2mm x 3mm x 3mm x NA

Recon Spacing 5mm 5mm 1mm 3mm 3mm

Plane AX AX AX SAG COR NA

Reconstruction ST LUNG ST ST ST NA
Algorithm

Send to PACS PACS HOLD PACs PACS NA

39
Abdomen Pelvis: FAST ER Protocol: R/O Acute
Appendicitis or Diverticulitis
** For ER Patients with BMI >30 and Age >16 ** THIS IS NOT FOR ABSCESS:: INTR-ABDOMINAL
ABSCESS EVALUATION NEEDS ORAL CONTRAST
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non
Contrast N N/A N/A

Arterial N N/A N/A

Phase
Venous Y 60-70 SECS Inspiration Domes diaphragms thru
Phase lesser trochanters
Delayed N N/A N/A
Phase

Scan Comments: This is a limited scan focused to exclude acute cases of typical appendicitis in
obese adults. If there is clinical suspicion for Abdominal Abscess then ORAL contrast is needed
Atypical presentations including prolonged symptoms or signs suggesting abscess are optimally
imaged with oral contrast. Thin patients with BMI <30 and/or <16 years old use AbdPelvis CT:
Routine. NOTE: Oral Contrast is critically important in thin patients and children to successfully
exclude appendicitis.
Contrast Parameters Parameters
Contrast Type Per Institution
Contrast Volume 100cc
Injection Rate 3-4cc/sec
Oral Contrast None
Oral Contrast Volume N/A
Contrast Comments:

40
 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data

Slice Thickness x 5mm x 5mm x 2mm x 3mm x 3mm x NA

Recon Spacing 5mm 5mm 1mm 3mm 3mm

Plane AX AX AX NA COR NA

Reconstruction ST LUNG ST NA ST NA
Algorithm

Send to PACS PACS HOLD PACs PACS NA

41
Abdomen CTA- Aortic Aneurysm -Pre EVT
Typical Indications: f/u known or suspected abdominal aneurysm, preop evaluation stent graft
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non N** N/A N/A Dome Diaphragms to
Contrast iliac crests
Arterial Y Use Bolus Inspiration Domes Diaphragms thru
Phase Tracking lesser trochanters
Venous N N N/A
Phase
Delayed N N/A N/A
Phase

Scan Comments:
For routine f/u abdominal aneurysm or initial preop evaluation Noncontrast phase not
needed.
** For Acute Abdominal Pain with r/o dissection include NonContrast CT to evaluate for
acute intramural hematoma:
**For POST Endovacular Stent Graft patients add NonContrast phase thru chest/abd
stent graft region: See Abdomen Aorta CTA Post EVT protocol
Contrast Parameters Parameters
Contrast Type Per Institution
Contrast Volume 75-80cc routine
100 cc if combining with chest
Injection Rate 4-5cc/sec
Oral Contrast N/A
Oral Contrast Volume DO NOT GIVE ORAL CONTRAST; if scout shows barium consider
delaying exam for elective cases

42
 Reconstruction Soft Bone/ Thin Data Sag Cor 3D/Special
Parameters Tissue Lung

Slice Thickness x 2mm x 5mm x 1mm x 3mm 3mm x #3) 3D radial MPR
Recon Spacing 2mm 5mm 0.5mm x 3mm #4) 5mm thick
3mm MIPs in SAG and
COR

Plane Axial Axial Axial Sag Cor 3) Radial Range

4) SAG/COR

Reconstruction Soft Tissue Lung ST ST ST ST

Algorithm

Send to PACS PACS 1. To 3D PACS PACs PACs : Reformat

server 3Ds AFTER
2. PACS transferring raw
data to PACS

43
Abdomen CTA- Aortic Aneurysm –Post EVT
Typical Indications: f/u known or suspected thoracic aneurysm, preop evaluation stent graft
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Y** N/A N/A Domes diaphragms
Contrast thru symphysis
Arterial Y Use Bolus Inspiration Domes diaphragms
Phase Tracking thru lesser trochanters
Venous N N N/A
Phase
Delayed N N/A N/A
Phase

Scan Comments:
For routine f/u thoracic aneurysm noncontrast not needed.
** For Acute Chest Pain with r/o dissection include NonContrast CT to evaluate for
acute intramural hematoma: See CTA Acute Aorta
**For POST Endovacular Stent Graft patients add NonContrast phase thru chest/abd
stent graft region
Contrast Parameters Parameters
Contrast Type Per insitution
Contrast Volume 75-80cc routine
100 cc if combining with chest CTA
Injection Rate 4-5cc/sec
Oral Contrast N/A
Oral Contrast Volume N/A
Contrast Comments: DO NOT GIVE ORAL CONTRAST; if scout shows barium consider
delaying exam for elective cases

44
 Reconstruction Soft Bone/ Thin Data Sag Cor 3D/Special
Parameters Tissue Lung

Slice Thickness x 2mm x 5mm x 1mm x 3mm x 3mm x #3) 3D radial MPR
Recon Spacing 2mm 5mm 0.5mm 3mm 3mm #4) 5mm thick
MIPs in SAG and
COR

Plane Axial Axial Axial Sag Cor 3) Radial Range

4) SAG/COR

Reconstruction Soft Lung ST ST ST ST

Algorithm Tissue

Send to PACS PACS 1. To 3D PACS PACs PACs : Reformat

server 3Ds AFTER
2. PACS transferring raw
data to PACS

45
CT COLONOGRAPHY
Indications: Screening or Diagnostic
Acquisition Phase Scan Respiration Anatomical
Included Delay Phase Coverage
Phase
Non Y Domes diaphragms thru
Contrast Sup + Prone N/A Inspiration lesser trochanters
Arterial Phase N/A N/A N/A

Venous Phase N/A N/A N/A

Delayed Phase N/A N/A N/A

Scan Comments: Scan acquisitions in both Supine and Prone position
Contrast Parameters Parameters
Contrast Type Air per rectum
Contrast Volume 50 puffs hand mechanical
Scout after insufflation to assess air adequacy
Saline Flush N/A

Injection Rate N/A

Oral Contrast Tagitol Oral prep protocol

Oral Contrast Volume Tagitol V 3 bottles @ 20 ml each at 0800, 1200, 1700 day before
See Virtual Colonography Prep Protocol: For Screening use
Contrast Comments: Tagitol Oral Prep; For Diagnostic Cases coming from Incomplete
Endoscopy may scan immediately without Tagitol prep

Reconstruction Parameters Soft Tissue Lung Thin Data

Slice Thickness 5mm 5mm 0.5mm
Reconstruction Spacing 5mm 5mm 0.5mm
Reconstruction Algorithm Soft Tissue Lung Soft Tissue
B30f B80f B30f
Window and Level 400/40 1500/-500 400/40
Supine and Prone Axial 5x5 mm in Soft Tissue to PACS
Reconstruction Comments: Lung 5 x 5 mm Recons to PACS
Sag/Cor recons 3 x 3 Soft Tissue to PACS
Supine and Prone Thin Data Sets to 3D Server (Terarecon) Only

46
Insufflation Technique
1. Left down decubitus. Inflate balloon in rectum; pull back to create seal at anorectal
junction; tape catheter to cheeks; Turn on CO2 with maximum pressure (the machine’s
computer starts at a low pressure and gradually increases it, no need to do this
manually). Inflate first 1000 mL in LLD position. Roll patient to supine for 2 nd 1000 mL.
When pressure equilibriates to 25 mm and/or 2000 mL is reached then do supine scout.
Do not turn off the gas. Check the scout. If the patient is full of stool find out if they
took the prep, and if not send them home to reprep. If there is a nondistended
segment, try rolling the patient so that segment is UP (air rises). Make sure tip is still in
the rectum. Re-scout. If still not well distended, try hand insufflation (locate plastic bag
in the tubing between pump and patient; occlude tubing between bag and patient; bag
fills with gas; occlude tubing between bag and pump; squeeze contents of bag into
patient. Repeat sequence of maneuvers several times. Pump will shut off automatically
at 4 liters. If this happens, turn it back on. Repeat scout. Scan. Check axial images for
non-distended segments. Make a note of them. Turn patient prone. DO NOT TURN
OFF THE GAS. Place boosters underneath thighs and chest. If pump turns off by itself
put it back on. Wait a minute or two. Rescan. If there is a non-distended segment
repeat procedure above. Scan. Check axial images for non-distended segments. If
there is an area nondistended on both supine and prone do a third scan (after
additional insufflation) in a decubitus or oblique with the collapsed segment up.
2. Alternate method of manual insufflation- cut tubing with scissors between bag and
patient; attach blue puffer bulb and insufflate room air. About 10 puffs should do if
there is CO2 in there already. This may overcome ileocecal reflux or slight rectal
sphincter incompetence. A complete exam can be done if the pump breask or you run
out of CO2 using 50 bulb squeezes supine, then additional 10 after position change.
3. If gas escapes: use large bore tip with a big balloon

47
CT Enterography
Typical Indications: Suspected or known Crohn’s, small bowel tumor, GI bleeding, malabsorption..
THIS IS NOT FOR ISCHEMIA- see CTA
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Contrast N N/A N/A
Arterial Y* for occult GI Use Inspritation Mid liver to bottom of
Phase bleeding/tumor Bolus Tracking ischial tuberosities
Enteric Phase Y* 20 SECS after Inspiration Mid liver to bottom of
(Crohn’s) arterial phase ischial tuberosities
(50 seconds total)
Delayed No for Crohn’s 90 SECS after Inspiration Mid liver to bottom of
Phase Yes for Occult GI arterial phase ischial tuberosities
Bleed/Tumor
Scan Comments: Biphasic and Triphasic scanning in young patients requires special
consideration of lowering scan dose:
1) Scan range is directly related to the total radiation dose ; therefore, if the primary
focus is imaging of the small bowel, coverage can be reduced to exclude the lung
bases, breast tissue, and top of the liver. Imaging should be performed through the
perineum, since perianal fistulas can be an essential diagnostic clue in Crohn colitis
and may not be recognized clinically.
2) Dose reduction and improved lesion detection with lower kVP to 80-100 in normal
to thin patients. Mucosal hyperenhancement and mural stratification of inflamed
bowel are more pronounced at lower tube potentials, thus improving the conspicuity
of abnormal segments. A potential radiation dose savings of 16%–30% can be
achieved by reducing the kilovolt peak to 80 or 100 kVp.

From: July 2013 RadioGraphics, 33, 1109-

1124.
Crohn disease or other diffuse bowel pathology: Enteric phase study only
(approximately 50 seconds after start of injection) is sufficient.
For occult GI bleeding and search for GI malignancy: arterial, enteric, and delayed
scans are usually needed. Before giving IV contrast perform a low mA single slice
through mid abdomen or topogram and check if there is adequate bowel distention.
(Make sure most of Volumen is not in stomach) Pts need to be NPO 6hours except
meds and oral contrast protocol. If patient cannot drink contrast NG tube required.
Follow Volumen Protocol.

48
 Contrast Parameters Parameters

Contrast Type Isovue 300

Contrast Volume 100cc

Injection Rate 4-5cc/sec

Oral Contrast Volumen

See Volumen protocol

Oral Contrast Volume

For Gastric Mass/Ulcer

Contrast Comments: evaluation use H2O
water protocol
 Scan Supine and
have rad review
need on while
patient table to
assess need for
Prone images
Reconstruction Soft Thin
Bone/ Lung Sag Cor
Parameters Tissue Data
Slice Thickness x 3mm x 5mm x 1mm x 3mm 3mm
Recon Spacing 3mm 5mm 0.5mm x x
3mm 3mm
Plane
Axial Axial Axial Sag Cor

Reconstruction Algorithm Soft Tissue Lung ST ST ST

Send to PACS PACS 1. To 3D PACS PACs

server
2. PACS

49
50
CT UROGRAM
Typical Indications: hematuria; bladder mass; see Renal Mass Protocol for known renal mass
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non
Contrast Y N/A Inspiration Kidneys thru lesser
trochanters
Arterial
Phase/Early Y Approx 30 secs Inspiration Kidneys
Corticomedullary
Phase

Venous Phase/ Domes diaphragms

Nephrographic Y 80-90 seconds Inspiration thru lesser trochanters
Phase

Delayed Phase/ Y* 8-10 minutes Inspiration Kidneys thru lesser

Urographic Phase trochanters

Scan Comments: Patients should be well hydrated for exam. *For

Renal Mass protocol only do NonContrast, Arterial, and
Nephrographic Phases ( no urographic phase).
If obstructing renal stone identified on noncontrast contact
Radiologist- may be able to omit other phases
Contrast Parameters Parameters

Contrast Type Per Institution

Contrast Volume 100cc

Injection Rate 4-5 cc/sec

Oral Contrast H20

Oral Contrast Volume 800cc

400 cc H20 20 minutes

Contrast Comments: prior to scan
400 cc H20 on table

51
 Reconstruction Soft Tissue B Thin Sag Cor
Parameters o Data
n
e/
Lu
n
g

Slice Thickness x 5mm 5 2mm 3mm 3mm

Recon Spacing 5mm m 1mm 3mm 3mm
m
5
m
m
Plane AX A AX NA COR
X

Reconstruction ST L ST NA ST
Algorithm U
N
G

Send to PACS P HOL PACs PACS

A D
CS

52
CT UROGRAM LOW DOSE
CT LOW DOSE UROGRAM- TRIPHASIC INJECTION
Typical Indications: “hematuria; bladder mass”

Acquisition Phase Scan Respiration Anatomical

Phase Included Delay Phase Coverage
Non
Contrast Y N/A Inspiration Kidneys
thru lesser
trochanters
Combined
Nephrographic/ Y 1)30cc @ Inspiration Domes thru
Urographic Phase 2cc/sec bottom of
Then NS flush symphysis
200cc pubis joint
@1.5cc/sec
Pause 10 mins
2) 55cc @
1.5cc/sec
Pause 20 secs
3)65cc @ 3
cc/sec

53
Reconstruction Soft Tissue Lung Thin Data
Parameters
5mm 5mm 2mm
Slice Thickness

5mm 5mm 2mm

Reconstruction Spacing

Soft Tissue Lung ST

Reconstruction Algorithm B30f B80f

400/40 1500/-500 400/40

Window and Level

54
Renal Mass
Typical Indications: abnormal renal ultrasound/suspected renal mass
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Y N/A Inspiration Kidneys 5 x 5mm
Contrast
Corticomedullary Top of Liver to bottom
Phase Y 30-40 secs Inspiration of Kidneys
5 x 5mm
Nephrographic Y 90 secs Inspiration Top of Liver to Lesser
Phase Trochanters
DelayedPhase N N/A N/A N/A

Scan Comments:

Contrast Parameters
Parameters
Contrast Type Per institution

Contrast Volume 100cc

Injection Rate
3cc-4cc/sec

Oral Contrast H20 Oral Contrast protocol

400 ml H20 20 minutes prior to scan
Contrast Comment 400 ml H20 on table

55
 Reconstruction Soft Tissue Bone/ Thin Sag Cor
Parameters Lung Data

Slice Thickness x 5mm x 5mm x 2mm 3mm 3mm

Recon Spacing 5mm 5mm x x x
1mm 3mm 3mm

Plane AX AX AX NA COR

Reconstruction Algorithm ST LUNG ST NA ST

Send to PACS PACS HOLD PACs PACS

56
Renal CTA
Typical Indications: r/o renal artery stenosis
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non N N/A N/A N/A
Contrast
Arterial Y Use Bolus Inspiration Dome diaphragm thru
Phase Tracking iliac crests
Venous N N N/A
Phase
Delayed N N/A N/A
Phase

Contrast Parameters Parameters

Contrast Type Per institution
Contrast Volume 80cc

Injection Rate 4-5cc/sec

Oral Contrast N/A

Oral Contrast Volume N/A

Contrast Comments:

57
 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data

Slice Thickness x 3mm x 5mm x 1mm x 3mm x 3mm x 1) 3D radial MPR

Recon Spacing 3mm 5mm 0.5mm 3mm 3mm 2) 5mm thick MIPs
in SAG and COR

Plane Axial Axial Axial Sag Cor 1) Radial Range

2) SAG/COR

Reconstruction Soft Tissue Lung ST ST ST ST

Algorithm

To 3D PACs : Reformat
server 3Ds AFTER
Send to PACS PACS PACS PACs
then to transferring raw
PACS data to PACS

58
Retroperitoneal Hemorrhage
Typical Indications: post heart cath r/o bleeding, unexplained drop in Hg/Hct, r/o acute bleeding
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Y N/A Inspiration Domes diaphragms thru
Contrast lesser trochanters 5 x
5mm
Arterial N* Bolus Tracking Inspiration
Phase
Venous N N N/A
Phase
Delayed N* N/A N/A
Phase
Scan Comments: Consider IV contrast if Noncontrast Positive and/or if needed to detect
acute vascular extravasation (especially immediately post heart cath, recent biopsy, or
trauma)
If extravasation seen on initial scan call radiologist and consider delayed scans thru area
of extravasation depending on patient condition
Contrast Parameters Parameters
Contrast Type Per Institution
Contrast Volume 100cc
Injection Rate 4-5cc/sec
Oral Contrast None
Oral Contrast Volume N/A
Contrast Comments

59
 Reconstruction Soft Bone/ Thin Data Sag Cor 3D/Special
Parameters Tissue Lung

Slice Thickness x 5mm x 5mm x 1mm x 3mm x 3mm x NA

Recon Spacing 5mm 5mm 0.5mm 3mm 3mm

Plane Axial Axial Axial Sag Cor NA

Reconstruction Soft Tissue Lung ST ST ST NA

Algorithm

Send to PACS PACS Hold PACS PACs NA

60
Oncology: Hepatoma: (Triphasic Liver CT)
Typical Indications: Staging: Hepatoma; Hepatocellular CA; h/o liver cirrhoiss r/o HCC screening for
hepatoma
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Y N/A Inspiration Liver
Contrast
Arterial Y Use arterial Inspiration Liver
Phase bolus tracking
software
Venous Y 60-70 SECS Inspiration Domes diaphragms
Phase thru lesser
trochanters
Delayed Y 3minutes Inspiration Liver
Phase/Equilibrium
Phase

Scan Comments: This is the standard triphasic liver CT.

Contrast Parameters Parameters
Contrast Type Per institution
Contrast Volume 100cc
Injection Rate 4cc/sec
Oral Contrast H20 Protocol
Oral Contrast Volume 400 cc H20 PO 20 minutes prior to scan
400c H20 PO on table
Contrast Comments:

61
 Reconstruction Soft Bone/ Thin Data Sag Cor 3D/Special
Parameters Tissue Lung

Slice Thickness x 5mm x 5mm x 1mm x 3mm x 3mm x NA

Recon Spacing 5mm 5mm 0.5mm 3mm 3mm

Plane Axial Axial Axial Sag Cor NA

Reconstruction Soft Tissue Lung ST ST ST NA

Algorithm

Send to PACS PACS Hold PACS PACs NA

62
Oncology: Cholangiocarcinoma
Typical Indications: Staging: cholangiocarinoma, bile duct tumor
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non N N/A N/A
Contrast
Arterial Y 25-30 SECS Inspiration Liver
Phase
Venous Y 60-70 SECS Inspiration Domes diaphragms
Phase thru lesser
trochanters*
Delayed Y 8 minutes Inspiration Liver
Phase

Scan Comments: * Include pelvis during PVP if ordered

Contrast Parameters Parameters
Contrast Type Per institution
Contrast Volume 75- 80 cc routine
100cc if combined with CAP
Injection Rate 4cc/sec

Oral Contrast Per institution

Oral Contrast Volume Per institution

Contrast Comments: May use 800 cc H20 as alternative to positive oral contrast if
only scanning liver

63
 Reconstruction Soft Bone/ Thin Data Sag Cor 3D/Special
Parameters Tissue Lung

Slice Thickness x 5mm x 5mm x 1mm x 3mm x 3mm x NA

Recon Spacing 5mm 5mm 0.5mm 3mm 3mm

Plane Axial Axial Axial Sag Cor NA

Reconstruction Soft Tissue Lung ST ST ST NA

Algorithm

Send to PACS PACS Hold PACS PACs NA

64
Pancreatic Mass CT
Typical Indications: Evaluate Pancreatic Mass
(For evaluation standard pancreatitis use Routine Abdomen Pelvis CT)
Acquisition Phase Scan Respiration Anatomical
Phase Included Delay Phase Coverage
Non Y N/A Inspiration Liver through pancreas
Contrast
Arterial Y Use bolus tracking Inspiration Liver through pancreas
Phase software
Venous Y 60-70 SECS Inspiration Domes diaphragms
Phase thru lesser trochanters
Scan Comments: Acute Pancreatitis: work-up should be done as Routine Abdomen-pelvis.
For Pancreas cases OPACIFICATION AND DISTENTION OF DUODENUM IS VERY IMPORTANT-
drink additional oral contrast immediately before scan and consider placing patient right side
down for 2-3minutes prior to scanning to mobilize contrast into duodenum. Venous phase
through pelvis if pelvis CT ordered.
Contrast Parameters Parameters
Contrast Type Per Institution
Contrast Volume 75-80cc routine
100 cc if combined with CAP
Injection Rate 4cc/sec
Oral Contrast Per institution

Oral Contrast Volume

Contrast Comments: Be sure to give extra oral contrast immediately prior to scanning
to distend stomach/ duodenum. Check for adequacy of duodenal
contrast on un-enhanced series

65
 Reconstruction Soft Bone/ Thin Data Sag Cor 3D/Special
Parameters Tissue Lung

Slice Thickness x 3mm x 3mm x 1mm x 3mm x 3mm x NA

Recon Spacing 3mm 3mm 0.5mm 3mm 3mm

Plane Axial Axial Axial Sag Cor NA

Reconstruction Soft Lung ST ST ST NA

Algorithm Tissue

Send to PACS PACS Hold PACS PACs NA

66
CT VENOGRAM PELVIS: Pelvic Venous Congestion
Typical Indications: Evaluate Ovarian Vein Reflux/ Pelvic Venous Congestion ; pelvic
varicosities, exclude pelvic vein or lower extremity deep venous thrombosis
:

Acquisition Phase Scan Respiration Anatomical

Phase Included Delay Phase Coverage
Non
Contrast N N/A N/A N/A

Arterial N/A
Phase N N/A N/A

Venous Top of Kidneys to

Phase Y 3MINS QUIET below Lesser
Trochanters
Delayed
Phase N N/A N/A N/A

Scan Comments: MAY BE ABLE TO DECREASE KVP TO 100 OR 80 IN SMALL PTS

Contrast Parameters Parameters

Isovue 370
Contrast Type

Contrast Volume 100CC

Injection Rate 2CC/sec CONTRAST

2CC/SEC SALINE FLUSH X 30 CC

Oral Contrast N/A

N/A
Oral Contrast Volume

Contrast Comments: SCAN DELAY 3 MINUTES

67
Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data

Slice Thickness x 1MM X N/A 0.75MM X 3mm x 3mm x SEND

Recon Spacing 1MM 1MM 3mm 3mm THINSTO
PACS FOR MD
RECONS

Plane
Axial N/A Axial Sag Cor AX

Reconstruction Soft Tissue N/A ST ST ST ST

Algorithm

Send to PACS N/A TO TERA PACS PACs DONE BY MD

68
LOWER EXTREMITIES

69
CT VENOGRAM LOWER EXTREMITY
Typical Indications: Evaluate Venous varicosities, exclude pelvic vein or lower extremity
deep venous thrombosis
:

Acquisition Phase Scan Respiration Anatomical

Phase Included Delay Phase Coverage
Non
Contrast N N/A N/A N/A

Arterial N/A
Phase N N/A N/A

Venous TOP OF L4 TO FEET

Phase Y 3MINS QUIET

Delayed
Phase N N/A N/A N/A

Scan Comments: IF PATIENT IS BEING SCANNED TO RULE OUT OVARIAN VEIN REFLUX,
PELVIC VENOUS CONGESTION PLEASE SEE OVARIAN VEIN REFLUX/ PLEVIC VENOUS
CONGESTION PROTOCOL. MAY BE ABLE TO DECREASE KVP TO 100 OR 80 IN SMALL PTS

Contrast Parameters Parameters

Isovue 370
Contrast Type

Contrast Volume 100CC

Injection Rate 2CC/sec CONTRAST

2CC/SEC SALINE FLUSH X 30 CC

Oral Contrast N/A

N/A
Oral Contrast Volume

Contrast Comments: SCAN DELAY 3 MINUTES

70
Reconstruction Soft Bone/ Thin Sag Cor 3D/Special
Parameters Tissue Lung Data

Slice Thickness x 1MM X N/A 0.75MM X 3mm x 3mm x SEND

Recon Spacing 1MM 1MM 3mm 3mm THINSTO
PACS FOR MD
RECONS

Plane
Axial N/A Axial Sag Cor AX

Reconstruction Soft Tissue N/A ST ST ST ST

Algorithm

Send to PACS N/A TO TERA PACS PACs DONE BY MD

71
72
73