CT Scan
Protocols
For
Radiology
Department, cll
Prepared By
Waseem Zafar
MIT Consultant
Reviewed by
Dr.Furqan Ahmed
(HOD)
1
Approved By
CONTENTS
Section 1
Head & Neck
Head (Helical)
Head (S&S)
IAC (Helical)
IAC (S&S)
Sinuses
Neck (soft tissue)
Section 2
Body
Chest
Chest (High Resolution)
Abdomen (Routine)
Liver (Hypervascular)
Liver (Hypovascular)
Pancreas
Kidneys
Pelvis (Soft tissue)
CAP (Hypervascular)
CAP (Hypovascular)
Section 3
Vascular
CTA Head
CTA Carotid
CTA Pulmonary Angiogram
CTA Thoracic Aorta
CTA Abdominal Aorta
CTA Whole Aorta
Femoral Run-off (Dual scan)
Femoral Run-off (Single scan)
Calcium Score
CTA Cardiac
CTA Bypass
Section 4
Musculoskeletal
Cervical Spine
Spine
Lumbar Spine
Shoulder
Elbow
Wrist
Pelvimetry
Bony Pelvis
Hip
Knee
Ankle
Leg Length
2
CT Head & Neck – Head (S&S)
Indications:
Headaches, dementia, memory loss, CVA
Post contrast if indicated on non-contrast series or;
SOL ?Metastases from lung, breast, melanoma,
Patient preparation:
Supine/Head First, taking care to position head
symmetrically, OM baseline parallel to scan plane
Imaging protocol: [Brain S&S 4mm]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan range:
Start
End
Plane
1cm below base of skull
Above apex of skull
Parallel to OM baseline
Contrast:
Volume
Rate/Delay
50ml
Hand injection
Image reconstruction:
4/4mm Head Brain
Comments:
This program can produce 2mm slices if required
3
2mm
n/a
120
250
1.5 – 1.0
CT Head & Neck – Head (Helical)
Indications:
Headaches, dementia, memory loss, CVA
Post contrast if indicated on non-contrast series or;
SOL,? metastases from lung, breast, melanoma,
Patient preparation:
Supine/Head First, taking care to position head
symmetrically, OM baseline parallel to scan plane
Imaging protocol:
[Brain HCT 5mm (1mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan range:
Start
End
Plane
1cm below base of skull
Above apex of skull
Parallel to OM baseline
Contrast:
Volume
Rate/Delay
50ml
hand injection
Image reconstruction:
5/5mm Head Brain
1mmVolume Head Brain
Reformat:
Multiview
Start:
End:
Slice Thickness:
Spacing:
Coronal
Posterior
Anterior
4mm
4mm
Sagittal
Left
Right
4mm
4mm
Comments:
4
1mmx32
standard
120
300
0.75
IAC reformations can be made from this protocol.
CT Head & Neck – IAC’s (Helical)
Indications:
Otosclerosis, Cholesteatoma, Congenital
Hearing Loss, Bilateral sensori neural Hearing
Loss, Middle ear/mastoid inflammation,
Dehiscence **see comments
Patient preparation:
Supine/Head First, taking care to position head
symmetrically
OM baseline parallel to scan plane
Imaging protocol:
[IAC HCT 1mm (0.5mm)]
FOV 80mm, each side zoomed separately
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
0.5x64
Detail
120
200
0.5
Scan Range:
Start
End
Plane
Below mastoid tip
Above superior mastoid air cells
Parallel to OM baseline
Image reconstruction:
1/1mm
0.5/0.5mm
Bone High Resolution
Bone High Resolution
Reformat:
Multiview
Direction
Range
Thickness
Spacing
Coronal
Anterior to Posterior
Cover inner ear only
1mm
1mm
Comments:
For dehiscence must also do coronal & sagittal oblique reformations through semicircular canals.
5
CT Head & Neck – IAC (S&S)
Indications:
Otosclerosis, Cholesteatoma, Congenital Hearing Loss,
Bilateral sensori neural Hearing Loss, Middle
ear/mastoid inflammation
Patient preparation:
Supine/Head First, taking care to position head
symmetrically
Imaging protocol:
[IAC S&S 0.5mm ]
FOV 80mm, each side zoomed separately
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Below mastoid tip
Above superior mastoid air cells
Parallel to OM baseline
Image reconstruction:
0.5/0.5mm
Bone High Resolution
6
0.5x4
n/a
120
250
0.5
CT Head & Neck – Sinuses
Indications:
Sinusitis, polyps, Post nasal drip, #facial bones,
anosmia** see comments
Patient preparation:
Supine/Head First, taking care to position head
symmetrically.
Always ask if patient has had previous surgery, when it
was and document.
Imaging protocol:
[Sinuses HCT 5mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
0.5x64
Standard
120
100
0.5
Scan Range:
Start
End
Plane
Below maxillary sinuses
Above frontal sinuses
Parallel to hard palate
Image reconstruction:
5/5mm
Volume
Bone Sharp
Bone Sharp
Reformat:
Multiview
Coronal
Sagittal
Plane:
perpendicular to hard palate
perpendicular to hard palate
Start:
Anterior to frontals
medial wall of Left orbit
End:
Posterior to sphenoids
medial wall of Right orbit
Thickness:
2mm
2mm
Spacing:
2mm
2mm
If patient is not straight reformats may need to be performed manually to ensure correct
anatomical position.
7
Comments:
 If single opaque sinus, or completely opaque sinuses,
Then reconstruct 5/5mm axials SUREIQ - Soft Tissue Standard.
 If clinical indication is anosmia then reconstruct 5/5mm
Axials SUREIQ - Soft Tissue Standard and be sure to check
anterior cranial fossa for lesion (will require post contrast head
study)
 If scanning for a lump on the palate, scan patient with
mouth open (Have patient bite on a syringe)
8
CT Head & Neck – Neck (Soft Tissue)
Indications:
Parotid tumour, MNG, lymphadenopathy, **vocal cord
palsy requires Chest scan as well
Patient preparation:
Supine/Head First, position head symmetrically, dental
fillings parallel to scan plane.
Always ask if patient has had previous surgery and
document any details.
Place a marker over any lump
Imaging protocol:
[Neck HCT 3mm (1mm)]
Supplementary angled scans should be performed
in case of severe dental artefact around region of
interest
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Above pituitary fossa (angle of mandible for MNG)
Aortic arch
Straight gantry
Contrast:
Volume
Rate
Delay
75ml
2-3 ml/s
35s
Image reconstruction:
3/3mm
Volume
Neck Standard
Neck Standard
Reformat:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Posterior
Anterior
3mm
3mm
Sagittal
Left
Right
3mm
3mm
9
1x32
Standard
120
SUREExposure High Quality
0.5
CT Body – Chest
Indications:
Rule-out/follow-up 10 or 20 tumour of mediastinum or
lungs
Lymphoma staging
Investigate CXR abnormality
Hemoptysis
Patient preparation:
2 hr fast
Supine/Feet first
Imaging protocol:
[Chest HCT 5mm (1mm)]
[Lrg Chest HCT 5mm (1mm)]
When following-up peripheral lesions IV contrast may
not be required
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Above lung apices
Below adrenal glands
Straight gantry
Contrast:
Volume
Rate
Delay
70ml
2ml/s
35s
Image reconstruction:
5mm/5mm
5mm/5mm
Volume
Body Standard Axial
Lung Standard Axial
Body Standard Volume
Reformat:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Anterior
Posterior
4mm
4mm
Sagittal
Left
Right
4mm
4mm
Comments:
Measure lesion diameters and ROI’s on axial slices and reformats.
10
(1x32)
Standard
120
SUREExposure Standard
0.5 (0.75) (0.5)
CT Body – Chest (High Resolution)
Indications:
Asbestosis
Interstitial lung fibrosis
Industrial lung disease (silicosis)
Atypical infection
Sarcoidosis
Bronchiectasis
Patient preparation:
Supine/Feet First
Imaging protocol:
[Hi Rez Chest HCT (1mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Above lung apices
Below lung bases
Straight gantry
Image reconstruction:
5/0mm
Body Standard Axial
(This is for SUREExposure calculation. NO reconstruction)
1/10mm
Lung Sharp
Volume
Lung Standard Volume
Reformats:
Multiview
Start
End
Slice Thick
Spacing
Coronal
Posterior
Anterior
3mm
3mm
Sagittal
Left
Right
3mm
3mm
11
(1x32)
Standard
120
SUREExposure Standard
0.5
CT Body – Abdomen Routine
Indications:
Routine abdominal scan for non-specific referral
See other protocols for specific indications
Patient preparation:
4hr fast
Positive oral contrast 60/45/30/15mins prior, remainder
just prior to scan
Supine/ Feet first
Imaging protocol:
[Abdomen HCT 5mm (1mm)]
[Lrg Abdomen HCT 5mm (1mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Top of highest diaphragm
Below ischium
Straight gantry
Contrast:
Volume
Rate
Delay
70-120ml (depending on patient weight)
2-4ml/s
65-70s
Image reconstruction:
5/5mm
Volume
Body Standard Axial
Body Standard Volume
Reformat:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Anterior
Posterior
4mm
4mm
Sagittal
Left
Right
4mm
4mm
12
(1x32)
Standard
120
SUREExposure Standard
0.5 (0.75)
CT Body – Liver (Hypervascular)
Indications:
Rule out/follow-up liver for hypervascular metastases
from the following:
o Primary liver tumours
o Renal cell carcinoma, leiomyosarcoma, thyroid
tumours, carcinoid and other neuro-endocrine
tumours
o Melanoma and breast (can be hypovascular)
o Pancreas islet cell tumours, GIST (Gastrointestinal stromal cell tumour)
Patient preparation:
4hr fast
Positive oral contrast 60/45/30/15mins prior, remainder
just prior to scan
H20 may be suitable alternative (750mls 30min prior,
250mls immediately before scan)
Supine/Feet First
Imaging protocol:
[2 Phase Liver 5mm (1mm)]
[Lrg 2 Phase Liver 5mm (1mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
(1x32)
Standard
120
SUREExposure Standard
0.5 (0.75)
Scan range:
Start
End
Plane
Arterial Phase
Top of highest diaphragm
Iliac crests
Straight gantry
Portal Venous Phase
Top of highest diaphragm
Below ischium
Straight gantry
Contrast:
Volume
Rate
Delay
70-120mls (depends upon patient weight)
4ml/s
SUREStart150HU abdominal aorta +10 secs
Portal Venous @ 65s fixed delay
Image reconstruction:
5/5mm
Volume
Body Standard Axial
Body Standard Volume
Reformat:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Anterior
Posterior
4mm
4mm
Sagittal
Left
Right
4mm
4mm
13
CT Body – Liver (Hypovascular)
Indications:
Rule out/follow-up liver for hypovascular metastases
from the following:
o Primary adenocarcinoma in digestive tract
(oesophagus, stomach, colon and rectum),
pancreas or lung
o Squamous cell carcinoma (head and neck, lung,
anus)
o Lymphoma
Patient preparation:
4hr fast
Positive oral contrast 60/45/30/15mins prior, remainder
just prior to scan
H20 may be suitable alternative (750mls 30min prior,
250mls immediately before scan)
Imaging protocol:
[Abdomen 5mm (1mm)]
[Lrg Abdomen 5mm (1mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Above highest diaphragm
Below ischium
Straight gantry
Contrast:
Volume
Rate
Delay
70-120ml (depending on patient weight)
2-4ml/s
65-70s
Image reconstruction:
5/5mm
Volume
Body Standard Axial
Body Standard Volume
Reformat:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Anterior
Posterior
4mm
4mm
Sagittal
Left
Right
4mm
4mm
14
(1x32)
Standard
120
SUREExposure Standard
0.5 (0.75)
CT Body – Pancreas
Indications:
Detection & staging adenocarcinoma pancreas
Patient preparation:
4hr fast
H20 for oral contrast (750mls 30min prior, 250mls
immediately before scan)
Extra cup on table patient on Right side
Imaging protocol:
[2 Phase Pancreas 5mm (0.5mm)]
[Lrg 2 Phase Pancreas 5mm (1mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
(1x32)
Standard
120
SUREExposure Standard
0.5 (0.75)
Scan Range:
Start
End
Plane
Late Arterial Phase
Above pancreas
Below duodenum
Straight gantry
Portal Venous Phase
Top of highest diaphragm
Below ischium
Straight gantry
Contrast:
Volume
Rate
Delay
70-120ml (Depends upon patient weight)
3 - 4ml/s
Late Arterial (40s)
Portal Venous (70s)
Image reconstruction:
5/5mm
Volume
Body Standard Axial
Body Standard Volume
Reformat:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Anterior
Posterior
4mm
4mm
Sagittal
Left
Right
4mm
4mm
15
CT Body – Kidneys
Indications:
Suspicion renal cell carcinoma
Staging & assessment of renal mass
Patient prep:
4hr fast
Positive oral contrast 60/45/30/15mins prior, remainder
just prior to scan
H20 may be suitable alternative (750mls 30min prior,
250mls immediately before scan)
Imaging protocol:
[2 Phase Kidney 5mm (0.5mm)]
[Lrg 2 Phase Kidney 5mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
CM Phase
Above kidneys
Below kidneys
Straight gantry
Nephrographic Phase
Top of highest diaphragm
Below ischium
Straight gantry
Contrast:
Pre contrast upper abdomen
Inject 30mls contrast & wait 5min
Inject further 70mls contrast & scan following phases
Volume
Rate
Delay
70-120mls (Depends upon patient weight)
3 - 4ml/s
Corticomedullary Phase (40s)
Nephrographic Phase (100s)
Image reconstruction:
5/5mm
Volume
Body Standard Axial
Body Standard Volume
Reformat:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Posterior
Anterior
4mm
4mm
Sagittal
Left
Right
4mm
4mm
16
(1x32)
Standard
120
SUREExposure Standard
0.5 (0.75)
CT Body – Pelvis (soft tissue)
Indications:
Staging gynaecological tumours
Staging urological tumours
Follow-up after pelvic tumour surgery
Patient preparation:
4-hour fast
Oral contrast
Modest filling of bladder (do not void)
Supine/Feet First
Imaging protocol:
[Pelvis HCT 5mm (0.5mm)]
+/- >15min Delayed**
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
(Abdomen)
0.5x64
Detail
120
SUREExposure Standard
0.5
Scan Range:
Start
End
Plane
Iliac crests
Below ischium
Straight gantry
Contrast:
Volume
Rate
Delay
70-100mls (Depends upon patient size)
4ml/s
Late Arterial (40s)
Image reconstruction:
5/5mm
Volume
Body Standard Axial
Body Standard Volume
Reformat:
Multiview
Start
End
Image thickness
Spacing
Coronal
Posterior
Anterior
3mm
3mm
Sagittal
Left
Right
3mm
3mm
Comment:
** Delayed scans (CT urogram) only in case of obstruction to determine level of obstruction
Thick-slab MIP performed to show ureters
17
CT Body – CAP (Hypervascular)
Indications:
Rule out/follow-up for 10 that have hypervascular liver
metastases
o Renal cell carcinoma, leiomyosarcoma, thyroid
tumours, carcinoid and other neuro-endocrine
tumours
o Melanoma and breast
o Pancreas islet cell tumours, GIST (Gastrointestinal stromal cell tumour)
Patient preparation:
4hr fast
Oral contrast
Supine/Feet First
Imaging protocol:
[Chest/Abdomen HCT 5mm ((1x32)]
[Lrg Chest/Abdomen HCT 5mm (1mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan range:
Start
End
Chest
Lung apices
Inferior to liver
Abdomen
Diaphragm
Ischium
Contrast:
Volume
Rate
Delay
70-120ml (depending on patient weight)
2-4ml/s
Arterial (25s)
Portal venous (65s)
Image reconstruction:
5/5mm
5/5mm
Volume
Body Standard Axial
Lung Standard Axial (for first HCT scan only)
Body Standard Volume
Reformat:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Posterior
Anterior
4mm
4mm
Sagittal
Left
Right
4mm
4mm
18
(1x32)
Standard
120
SUREExposure Standard
0.5 (0.75)
CT Body – CAP (Hypovascular)
Indications:
Staging/follow-up for 10 that have hypovascular liver
metastases
o Lymphoma
o Adenocarcinoma in digestive tract
(oesophagus, stomach, colon and rectum),
pancreas or lung
o Squamous cell carcinoma (head and neck,
lung, anus)
Patient preparation:
4hr fast
Oral contrast
Supine/Feet First
Imaging protocol:
[Chest/Abdomen HCT 5mm ((1x32))]
[Lrg Chest/Abdomen HCT 5mm (1mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan range:
Start
End
Chest
Lung apices
Lung bases
Abdomen
Diaphragm
Ischium
Contrast:
Volume
Rate
Delay
70-120ml (depending on patient weight)
2-4ml/s
Arterial (35s)
Portal Venous (65s)
Image reconstruction:
5/5mm
5/5mm
Volume
Body Standard Axial
Lung Standard Axial (for first HCT bank only)
Body Standard Volume
Reformat:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Posterior
Anterior
4mm
4mm
Sagittal
Left
Right
4mm
4mm
19
(1x32)
Standard
120
SUREExposure Standard
0.5
CT Vascular – CTA Head
Indications:
Rule out/assess cerebral Aneurysm, vasculitis, Moya
Moya disease, ?VBI when intracranial vessel study is
requested
Patient preparation/set-up:
4hr fast
Supine/Head First, chin tucked down toward chest
Scan plane: Parallel to the base of skull.
Imaging protocol: [Brain CTA (0.5mm)]
Pre Head only if recent severe headaches
(to r/o subarachnoid bleed)
Post CE Head
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
2cm below base of skull
Mid head
Parallel to base of skull
Contrast:
Single phase contrast injection protocol
Phase 1
XXml @ 4-5ml/s
Phase 2 (Saline)
50ml@ 4-5ml/s
XX = (Scan time +10) x injection rate
SUREStart
in Manual mode at the level of the start of the scan.
Trigger the Helical scan as soon as contrast is seen.
Image reconstruction:
2/2mm
Volume
CTA Brain
CTA Brain
Comments:
If scan is being performed for screening of FHx of
cerebral aneurysm your institution may not require a
post contrast head if there are no other problems.
20
(0.5x64)
Detail
120
250
0.5
CT Vascular – CTA Carotid
Indications:
All Carotid a./Vertebral a. studies should include
Intracranial & Arch vessels, unless following up a known
lesion.
VBI, Carotid stenosis, Ameurosis fugax, TIA’s, vertebral
or carotid dissection, dizziness.
Patient position/instructions:
Supine/Head First
Head holder, chin tucked down towards chest, shoulders
pulled down.
Clearly instruct patient that they must not swallow
throughout the study.
Scans should be acquired during arrested inspiration.
Imaging protocol:
[Carotid CTA 3mm (0.5mm)]
Post CE head (always perform unless recent cerebral
imaging has been performed)
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
(0.5x64)
Detail
120
SUREExposure Standard
0.5
Scan range:
Nb. Scan direction is superior to inferior
Start
Upper 1/3rd head
End
Below origins of arch vessels
Contrast:
Single phase contrast injection protocol
Phase 1
XXml @ 4-5ml/s
Phase 2 (Saline)
50ml@ 4-5ml/s
XX = (Scan time +10) x injection rate
SUREStart
manual at base of skull, trigger as soon as contrast is seen.
Image reconstruction:
3/3mm
Volume
CTA Neck
CTA Neck
Comments:
Scan direction is superior to inferior to reduce venous contamination in the head, as well as
avoiding neat contrast artefacts over the aortic arch.
Right arm IV access is generally preferred unless Brachiocephalic pathology is suspected
If subclavian pathology is also being investigated then increase the FOV to L field.
21
CT Vascular – CTA Pulmonary Arteries
Indications:
Atypical chest pain, dyspnea,? pulmonary embolus
Patient preparation/set-up:
Supine/Feet First, arms above head
Imaging protocol:
[Pulmonary CTA 3mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
0.5x64
Standard
120
SUREExposure Standard
0.5
Scan Range:
Start
End
Plane
Above lung apices
Below lung bases
Straight gantry
Contrast:
Right Arm preferable for injection.
Single phase contrast injection protocol
Phase 1
XXml @ 4-5ml/s
XX = (Scan time +5) x injection rate
SUREStart
at the level of pulmonary trunk. Trigger at 60HU.
Image reconstruction:
3/3mm
5/5mm
Volume
Body Standard Axial
Lung Standard Axial
Body Standard Volume
Reformats:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Posterior
Anterior
3mm (MIP)
3mm
Comments:
Check scans for adequate pulmonary artery opacification prior to letting the patient go.
Valsalva effect may be the cause of failed examinations where contrast density is suboptimal.
22
CT Vascular – Thoracic Aorta
Indications:
Aneurysm, Dissection, Coarctation
Patient preparation/set-up:
4hr fast
Supine/Feet First
Imaging protocol:
[T-Aorta CTA 3mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
0.5x64
Standard
120
SUREExposure Standard
0.5
Above aortic arch
Below lung apices
Straight gantry
Contrast:
Single phase contrast injection protocol
Phase 1
XXml @ 4-5ml/s
Phase 2 (Saline)
50ml@ 4-5ml/s
XX = (Scan time +10) x injection rate
SUREStart
at the level of the aortic arch. Trigger at 180HU.
Image reconstruction:
3/3mm
Body Standard Axial
Volume
CTA Body
Comments:
Carefully monitor real time scan to ensure that you have adequate arterial opacification. Delayed
scans may be necessary in the case of aortic dissection and aortic rupture.
23
CT Vascular – CTA Abdominal Aorta
Indications:
AAA check size, ELG work-up/follow-up, ?Aneurysm
leak.
Patient preparation/set-up:
4hr fast
Supine/Feet First
Imaging protocol: [Aorta CTA 3mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Top of highest diaphragm
Below ischium
Straight gantry
Contrast:
Single phase contrast injection protocol
Phase 1
XXml @ 4-5ml/s
Phase 2 (Saline)
50ml@ 4-5ml/s
XX = (Scan time +10) x injection rate
SUREStart
at the start of the helical scan. Trigger at 200HU.
Image reconstruction:
3/3mm
Volume
Body Standard Axial
CTA Body
Comments:
Carefully monitor real time scan to ensure that you
Have adequate arterial opacification.
Delayed scans at 70 sec, are necessary to check for
ELG leaks.
24
0.5x64
Standard
120
SUREExposure Standard
0.5
CT Vascular – Whole Aorta CTA
Indications:
Aneurysm, Dissection, Coarctation
Patient preparation/set-up:
4hr fast
Supine/Feet First
Imaging protocol:
[Whole Aorta CTA 3mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Above aortic arch
Below ischium
Straight gantry
Contrast:
Single phase contrast injection protocol
Phase 1
XXml @ 4-5ml/s
Phase 2 (Saline)
50ml@ 4-5ml/s
XX = (Scan time +10) x injection rate
SUREStart
at the level of the aortic arch. Trigger at 180HU.
Image reconstruction:
3/3mm
CTA Body
Volume
CTA Body
Comments:
Carefully monitor real time scan to ensure that you
have good arterial opacification.
25
0.5x64
Standard
120
SUREExposure Low Dose
0.5
CT Vascular – Femoral Run-off (Dual scan)
Indications:
Claudication, rest pain, leg ulcers, PVD.
Patient preparation/set-up:


4hr fast
Supine/Feet First, pillow (not sponge or foam
pad) placed lengthwise under lower legs to raise
lower legs into same plane as abdominal
vessels, feet strapped together
Table height adjusted so that both abdomen &
legs are near centre of FOV

Imaging protocol:
[Femoral Run-off 0.5mm/0.5mm]
[Lrg Femoral Run-off 1mm/0.5mm]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
First scan
Top of highest diaphragm
Below knees
Straight gantry
0.5x64 (1x32, 0.5x64)
Standard
120
SUREExposure Standard, 200
0.5
Second scan
Above knees
Below ankles
Straight gantry
Contrast:
Dual phase injection protocol (no saline)
Phase 1
30mls @ 6ml/s
Phase 2
XX @ 3-4ml/s
XX = (scan time -10) x injection rate
SUREStart at aortic bifurcation. Trigger at 180HU.
Image reconstruction:
Volume Diaphragm to knees
Volume Knees to ankles
CTA Body
CTA Body
Reformats:
For first Helical bank only:
Multiview
Coronal
Start
Posterior
End
Anterior
Slice Thickness
3mm
Spacing
3mm
Comments:
Carefully monitor real time scan to ensure that you haven’t “outrun” the contrast. AAA’s, poor
cardiac output and popliteal aneurysms can all be causes for slow flow.
If you “outrun” the contrast be prepared to perform delayed scan(s) ASAP
26
CT Vascular – Femoral run-off (single scan)
Indications:
Claudication, rest pain, leg ulcers, PVD.
Patient preparation/set-up:
4hr fast
Supine/Feet First, pillow (not sponge or foam pad)
placed lengthwise under lower legs to raise lower legs
into same plane as abdominal vessels, feet strapped
together
Table height adjusted so that both abdo & legs are near
centre of FOV
Imaging protocol:
[Femoral Run-off 0.5mm 1 Run]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
0.5x64
Standard
120
SUREExposure Standard
0.5
Scan Range:
Start
End
Plane
Top of highest diaphragm
Below ankle mortice
Straight gantry
Contrast:
Dual phase injection protocol (no saline)
Phase 1
30mls @ 6ml/s
Phase 2
XX @ 3-4ml/s
XX = (scan time -10) x injection rate
SUREStart triggered at 180HU at aortic bifurcation
Image reconstruction:
Volume
CTA Body
Reformats:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Posterior
Anterior
3mm
3mm
Comments:
Carefully monitor real time scan to ensure that you haven’t
“outrun” the contrast.
AAA’s, poor cardiac output and popliteal aneurysms can all
be causes for slow flow.
If you “outrun” the contrast be prepared to perform delayed scan(s) ASAP
27
CT Vascular – Calcium Score
Indications:
Investigation of calcium load in coronary arteries
Nb. We recommend the 10-steps guide to coronary
CTA’s for detailed instructions for performing these
studies.
Patient position/set-up:
Supine/Feet First.
ECG dots placed on chest, arms above head.
Imaging protocol:
[Calcium score (3mm)]
Scan Slice Thickness
3mmx4
Pitch
n/a
kV
120
mA
300
Rotation Time
0.25
ECG % trigger determined by heart rate.
Image reconstruction:
3mm
Cardiac Ca Score
28
CT Vascular – CTA Cardiac
Indications:
Investigation of CAD, coronary stent assessment
Nb. We recommend the 10-steps guide to coronary
CTA’s for detailed instructions for performing this
examination.
Patient position/set-up:
Supine/Feet First.
ECG dots placed on chest, arms above head.
Imaging protocol:
[Cardiac CTA (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Carina
Below apex of heart
Straight gantry
Contrast:
Single phase contrast injection protocol
Phase 1
XXml @ 4-5ml/s
Phase 2 (Saline)
50ml@ 4-5ml/s
XX = (Scan time +10) x injection rate
SUREStart
on descending aorta at level of pulmonary trunk.
Trigger at 180HU.
Image reconstruction:
Use ImageXact to determine optimal phase for motion
free images.
Volume
Cardiac CTA
Comments:
SURECardio
should be used to ensure that pitch,
rotation speed and reconstruction method are optimized
for the scan
29
0.5x64
Determined by SURECardio
120
400
Determined by SURECardio
CT Vascular – CTA Cardiac Bypass
Indications:
Assessment of bypass graft patency
Nb. We recommend the 10-steps guide to coronary
CTA’s for detailed instructions for performing these
examinations.
Patient position/set-up:
Supine/Feet First.
ECG dots placed on chest, arms above head.
Imaging protocol: [Bypass CTA (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Above aortic arch (include subclavian arteries)
Below apex of the heart
Straight gantry
Contrast:
Single phase contrast injection protocol
Phase 1
XXml @ 4-5ml/s
Phase 2 (Saline)
50ml@ 4-5ml/s
XX = (Scan time +10) x injection rate
SUREStart
at aortic arch. Trigger at 180HU.
Image reconstruction:
Use ImageXact to determine optimal phase for motion free images.
0.5/0.3mm
Cardiac CTA
Comments:
SURECardio should be used to ensure that pitch, rotatoin speed
and reconstruction method are optimized for the scan.
30
0.5x64
Determined by SURECardio
120
400
Determined by SURECardio
CT Musculoskeletal – Cervical Spine
Indications:
? Disc protrusion, arms symptoms
Patient preparation:
Supine/Head First, arms in traction by side (pillow under
knees, ask patient to hold corners of pillow and relax
shoulders as much as possible)
Try to avoid cervical kyphosis
Imaging protocol:
[Cervical Spine 2mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan range:
Levels specified or
Routine C3-C7
Image reconstruction:
2/2mm
2/2mm
Volume
Spine Cervical
Bone Sharp
Spine Cervical
Reformats:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Posterior
Anterior
2mm
2mm
Sagittal
Left
Right
2mm
2mm
31
0.5x64
Detail
120
SUREExposure High Quality
0.5
CT Musculoskeletal – Spine
Indications:
? Disc protrusion, crush #
Patient preparation:
Supine/Feet First, arms above head.
If levels are not indicated on referral then mark superior
& inferior extent of symptoms as indicated by the patient.
Imaging protocol:
[Spine 3mm (0.5mm)]
[Lrg Spine 3mm (0.5mm)]
Use Boost3D if scanning through the shoulders
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Specified on request or between markers.
Plane
Straight gantry
Image reconstruction:
3/3mm
3/3mm
Volume
Spine Th-Lumbar
Bone Standard
Spine Th-Lumbar
Reformats:
Multiview
Start
End
Slice Thickness
Spacing
Coronal
Posterior
Anterior
2mm
2mm
Sagittal
Left
Right
2mm
2mm
32
0.5x64
Detail
120 (135)
SUREExposure High Quality
1.0 (1.5)
CT Musculoskeletal – Lumbar Spine
Indications:
LBP, Sciatica, Femoratica, ?spinal canal stenosis
Patient preparation:
Supine/Feet First, sponge under knees, can be scanned
in decubitus or prone position if unable to lie supine.
Imaging protocol:
[Lumbar Spine 3mm (0.5mm)]
[Lrg Lumbar Spine 3mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation time
0.5x64
Detail
135
SUREExposure High Quality
1.0 (1.5)
Scan range:
Levels specified otherwise:
Routine L2-S1
If patient <30yrs then L3-S1 unless specific symptoms @L2-3
Start
Above pedicle of L2
End
Below S1 (increase scan range to allow sufficient data MPR’s for L5-S1 disc)
Image reconstruction:
3/3mm
3/3mm
Volume
Spine Th-Lumbar
Bone Standard
Spine Th-Lumbar
Reformats:
Use Spine program in MPR
33
CT Musculoskeletal – Shoulder
Indications:
? Fracture of humerus or glenoid, OA.
Patient preparation:
Patient positioning is very important in achieving good
results.
o Separating the shoulders as for a “Swimmers
position” will greatly reduce streak artefact from
the contra-lateral shoulder
o Position shoulder as close to centre of FOV as
possible
Scan during arrested inspiration, quiet breathing if
breath-hold can’t be maintained
If patient is unable to raise contra lateral arm then get
them to lower it as much as possible to achieve shoulder
separation
Imaging protocol:
[Shoulder 2mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
0.5x64
Detail
135
250
0.5
Scan Range:
Start
End
Plane
Above clavicle and AC joint
Below tip of scapula
Straight gantry
Image reconstruction:
2/2mm
Bone Standard
Volume
Bone Standard
Volume for 3D Body Standard Volume.
Reformat:
Multiview
Coronal
Plane
Perpendicular to GH joint
Start
Posterior
End
Anterior
Slice Thickness
2mm
Spacing
2mm
Sagittal
Parallel to GH joint
Lateral
Medial
2mm
2mm
Reformats may need to be done manually to ensure correct anatomical position.
3D
AP, PA, SI, Lateral view (Neer’s view)
34
CT Musculoskeletal – Elbow
Indications:
Pain, fracture/dislocation, loose bodies.
Patient preparation:
Patient lies semi-prone with the elbow extended in the
supine position in centre of FOV.
Head tucked down toward chest
As a last resort elbow can be scanned whilst positioned
across upper abdomen/lower chest
Imaging protocol: [Elbow 2mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
0.5x64
Detail
120
100
0.5
Scan Range:
Start
End
Plane
Above humeral epicondyles
Below radial tuberosity
Straight gantry
Image reconstruction:
2/2mm
2/2mm
Volume
Volume for 3D
Bone Sharp
Soft Tissue Standard
Bone Sharp
Soft Tissue Standard
Reformat:
Multiview
Coronal
Plane:
Parallel to epicondyles
Start:
Posterior to elbow
End:
Anterior to elbow
Slice Thickness:
2mm
Spacing:
2mm
Sagittal
Perpendicular to epicondyles
Lateral epicondyle
Medial epicondyle
2mm
2mm
If elbow is not straight in gantry then reformats need to be done manually to ensure correct
anatomical position.
Comment:
3D reformats may be required to better demonstrate pathology
35
CT Musculoskeletal – Wrist
Indications:
Pain, fracture/dislocation.
Patient preparation:
Patient lies semi-prone with the elbow extended and
wrist positioned in the supine position in center of FOV.
Scans are routinely scanned in the axial plane but can
be acquired in the direct coronal and sagittal planes if
required.
Imaging protocol:
[Hand/Wrist 2mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
0.5x64
Detail
120
80
0.5
Scan Range:
Start
End
Plane
Below radio-ulnar joint
Mid metacarpals
Straight gantry
Image reconstruction:
2/2mm
2/2mm
Volume
Volume for 3D
Bone High Resolution
Soft Tissue Sharp
Bone High Resolution
Soft Tissue Sharp.
Reformat:
Multiview
Plane
Start
End
Image thickness
Spacing
Coronal
Parallel to wrist joint
Posterior to wrist joint
Anterior to wrist joint
2mm
2mm
Sagittal
Perpendicular wrist joint
Lateral to radius
Medial to ulna
2mm
2mm
If wrist is not straight in gantry then reformats need to be done manually to ensure correct
anatomical position.
If Scaphoid pathology then perform Coronal oblique:
Plane
Parallel to scaphoid
Start
Posterior to scaphoid
End
Anterior to scaphoid
Image Thickness
1mm
Spacing
1mm
Comment:
3D reformats may be required to better demonstrate pathology
36
CT Musculoskeletal – Pelvimetry
Indications:
To assess pelvic dimensions of the female pelvis.
Patient Preparation:
Patient should void prior to the examination.
Routine:
1.
Lateral scanogram of the entire pelvis to include from L5 to below the pubic bones.
2. AP scanogram of the entire pelvis to include from L5 to below the pubic bones.
NOTE: If the baby is breech then the entire abdomen should be included.
3.
One 10mm axial slice through the ischial spines. These can usually be seen on the AP scanogram and
are also usually at the level of the fovea.
NOTE: The patient must be positioned so that the pelvis is straight and not rotated!
Scan Slice Thickness
10mm
Pitch
n/a
kV
120
mA
50
Rotation Time
0.5
Please see the following for the measurements required.
AP Scanogram
1)
Transverse inlet – Measure the maximum diameter of the pelvic inlet
37
Axial Slice
2)
Interspinous – Measure the distance between the ischial spines.
Lateral Scanogram
1.
Conjugate – Measure from the sacral prominence to the superior pubic symphysis.
2.
AP mid plane – Measure from the mid symphysis pubis to measure through the level of the ischial
spines to sacrum.
3.
Sacropubic – Measure from the inferior pubis symphysis to the last fixed sacral segment.
38
Comments:
If unsure of landmarks check with the radiologist.
The lateral scanogram may need high exposure factors if all the appropriate landmarks are to be
visualised.
39
CT Musculoskeletal – Bony Pelvis
Indications:
To assess pelvic fractures, bone tumours
Patient preparation:
Supine/Feet First, legs flat & feet/ankles secured
together
Imaging protocol:
[Bony Pelvis HCT 5mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
0.5x64
Standard
135
250
0.5
Scan Range:
Start
End
Plane
Above iliac crests
Below ischium
Straight gantry
Image reconstruction:
5/5mm
Volume
Volume for 3D
Bone Standard
Bone Standard
Body Standard Volume
Reformat:
Start
End
Slice Thickness
Spacing
Coronal
Posterior to sacrum
Anterior to ASIS
3mm
3mm
Comments:
Sagittal and 3D reformats may be required to better demonstrate pathology.
40
CT Musculoskeletal – Hip
Indications:
To assess fractures, bone tumour, trauma, arthritis
Patient preparation:
Supine/Feet First, legs flat & feet/ankles secured
together
Imaging protocol:
[Hip HCT 3mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Above acetabulum
Below lesser tuberosity of femur
Straight gantry
Image reconstruction:
3/3mm
Volume
Volume for 3D
Bone Standard
Bone Standard
Body Standard Volume
Reformat:
Start
End
Slice Thickness
Spacing
Coronal
Posterior
Anterior
3mm
3mm
Comments:
Sagittal and 3D reformats may be required to better
demonstrate pathology.
41
0.5x64
Detail
135
250
0.5
CT Musculoskeletal – Knee
Indications:
?#, loose body, OA, OCD, lesion, bone integrity around
TKR
Patient preparation:
Knee of interest in center of FOV, 20 deg flexion
Contra lateral leg straight down table unless it has a
TKR, then:
o Bend contra lateral leg 45deg so that metallic
component is not in scan range
Imaging protocol:
[Knee 2mm (0.5mm)]
If assessing TKR increase mA
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
0.5x64
Detail
120
150
0.5
Scan Range:
Start
End
Plane
Above femoral epicondyles
Below tibial tuberosity
Straight gantry
Image reconstruction:
2/2mm
2/2mm
Volume
Volume for 3D
Bone Sharp
Soft Tissue Standard
Bone Sharp
Soft Tissue Standard.
Reformat:
Coronal
Posterior
Anterior
3mm
3mm
Start
End
Slice Thickness
Spacing
Sagittal
Left
Right
3mm
3mm
For better demonstration of the ACL the following reformats should be performed
Plane
Start
End
Slice Thickness
Oblique Coronal
Parallel to posterior femoral condyles
Posterior to femoral condyles
Anterior to femur
2mm
Oblique Sagittals
Parallel to plane of ACL (planned off axial)
Lateral to Lat fem Condyle
Medial to Med Fem Condyle
2mm
Spacing
2mm
2mm
3D
AP, PA, Left & Right Lateral, disarticulate joint & show tibia and femoral joint surfaces
42
CT Musculoskeletal – Ankle
Indications:
Tarsal coalition, talar or calcaneal pathology, ankle joint
pathology, loose bodies.
Patient preparation:
Supine/Feet First, ankle of interest in center of FOV,
other leg bent up
Ankle/foot immobilised
Imaging protocol:
[Ankle/Foot 2mm (0.5mm)]
Scan Slice Thickness
Pitch
kV
mA
Rotation Time
Scan Range:
Start
End
Plane
Above ankle joint
Below calcaneum
Straight gantry
Image reconstruction:
2/2mm
Volume
Volume for 3D
Bone Sharp
Bone Sharp
Soft Tissue Standard.
Reformat:
Plane
Start
End
Slice Thickness
Spacing
Coronal
True coronal
Posterior to calcaneum
Anterior to navicular
2mm
2mm
Sagittal
True sagittal
Lateral to fibula
Medial to tibia
2mm
2mm
Comment:
If fractured, then 3D’s are required
43
0.5x64
Detail
120
100
0.5
CT Musculoskeletal – Leg Lengths
Indications:
To assess differential leg lengths either congenital or post surgical. (Hip Prosthesis)
Patient Preparation:
The patient must be positioned so that the pelvis is not rotated and that the legs are straight in line with the
tabletop. Tape the feet together for patient immobilisation.
Routine:
A.P. Scanogram to include the ankle joint and the pelvis. (1100mm scan length)
Pre-operative Measurements
Femora: Measure from the most superior aspect of the femoral head to the most distal part of the medial
femoral condyle.
Tibia: Measure from the superior aspect of the tibial plateau between the intercondylar eminences to the
distal tibia at the mid ankle mortice.
Post-operative Measurements
– Hip prothesis or acetabular deformity.
–
Please see attached example.
These measurements need to be taken from a
common frame of reference in the pelvis, therefore
excluding post surgical hardware such as the
acetabular component of a hip prosthesis.
Draw a horizontal line through a common point in
the pelvis,
E.g.: Ischial tuberosities
Draw a VERTICAL line from the mid point of the
ankle mortice to the horizontal line and measure
44
45